Provider Demographics
NPI:1104931351
Name:SKIRNYK, JAREMA JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JAREMA
Middle Name:JOHN
Last Name:SKIRNYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RIDGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5180
Mailing Address - Country:US
Mailing Address - Phone:630-325-0764
Mailing Address - Fax:630-325-0764
Practice Address - Street 1:2800 WEST 95TH STREET
Practice Address - Street 2:LITTLE COMPANY OF MARY HOSPITAL
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805
Practice Address - Country:US
Practice Address - Phone:708-229-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066509207L00000X, 208VP0014X
IL036-066509207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066509Medicaid
ILC46016Medicare UPIN