Provider Demographics
NPI:1568534774
Name:SKOWRONSKI, MEGAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:SKOWRONSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-440-3810
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-440-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525400080Medicare PIN
WI738440084Medicare PIN
WI650030036Medicare PIN