Individual
DR. JAN PAWEL SKOWRONSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
444 ROXBURY ROAD, ROCKFORD, IL 61107-5059
(815) 398-3000
(815) 398-3041
Mailing address
PO BOX 6003, ROCKFORD, IL 61126-6003
(815) 398-3000
(815) 391-5096
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
36112374
IL
207RI0011X
Interventional Cardiology Physician
Primary
36112374
IL
207UN0901X
Nuclear Cardiology Physician
36112374
IL
2085B0100X
Body Imaging Physician
36112374
IL
2085R0204X
Vascular & Interventional Radiology Physician
36112374
IL
2085U0001X
Diagnostic Ultrasound Physician
36112374
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112374 1
—
IL
01
—
101 15504
B/C B/S OF ILLINOIS
IL
01
—
CB0709/P0015992
RR MEDICARE GROUP #/PIN
GA
Enumeration date
07/12/2006
Last updated
01/22/2015
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