Individual
JEFFREY SKINNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050
(815) 759-4546
(815) 759-4110
Mailing address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050-8409
(815) 334-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036064948
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01620446
BLUE CROSS
IL
01
—
036064948
STATE LICENSE
IL
05
—
0360649481
—
IL
01
—
930106082
RAILROAD MCR
—
Enumeration date
06/07/2006
Last updated
06/07/2018
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