| Organization Name: | SKAN LLC |
| NPI Number: | 1316202344 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN A KHATER (DIRECTOR) |
| Mailing Address: | 3425 Drew Avenue Suite A Sandwich |
| State: | IL US |
| Postal Code: | 605482351 |
| Phone Number: | 8155705006 |
| Fax Number: | 8158461100 |
| NPI Enumeration Date: | 07/05/2012 |
| NPI Last Update Date: | 09/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QX0203X |
| License Number: | 75-3247165 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Oncology, Radiation |
| Taxonomy Definition: | |