Provider Demographics
NPI:1790710283
Name:SKOWRONSKI, JAN PAWEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:PAWEL
Last Name:SKOWRONSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6003
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61126-6003
Mailing Address - Country:US
Mailing Address - Phone:815-398-3000
Mailing Address - Fax:815-391-5096
Practice Address - Street 1:444 ROXBURY ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5059
Practice Address - Country:US
Practice Address - Phone:815-398-3000
Practice Address - Fax:815-398-3041
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112374207RC0000X, 207RI0011X, 207UN0901X, 2085B0100X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112374 1Medicaid
GACB0709/P0015992OtherRR MEDICARE GROUP #/PIN
IL101 15504OtherB/C B/S OF ILLINOIS
ILH59788Medicare UPIN
IL036112374 1Medicaid
ILK11995Medicare PIN