Provider Demographics
NPI:1972324200
Name:SKYLINE HEALTHCARE
Entity type:Organization
Organization Name:SKYLINE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUFYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULMUJEEB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-942-4785
Mailing Address - Street 1:8712 N OLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2024
Mailing Address - Country:US
Mailing Address - Phone:708-942-4785
Mailing Address - Fax:
Practice Address - Street 1:8712 N OLCOTT AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2024
Practice Address - Country:US
Practice Address - Phone:708-942-4785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty