Provider Demographics
NPI:1558105130
Name:SKALLERUD, WILLIAM KAI (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KAI
Last Name:SKALLERUD
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 ERIE CT STE 6160
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2510
Mailing Address - Country:US
Mailing Address - Phone:708-763-1490
Mailing Address - Fax:708-763-2162
Practice Address - Street 1:1 ERIE CT STE 6160
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2510
Practice Address - Country:US
Practice Address - Phone:708-763-1490
Practice Address - Fax:708-763-2162
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125-084586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program