Active NPI
Gary Steven Skaletsky, M.D.
- Specialist
- Sugar Grove, IL
National Provider Identifier
1689916223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 036-54690-1
- Practice address
- 40 Terry Dr
Sugar Grove, IL 60554-5429 - Phone
- (630) 803-4711
- NPI assigned
- Mar 21, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 036-54690-1 | IL | Primary |
Addresses
Primary practice location
40 Terry Dr
Sugar Grove, IL 60554-5429
Mailing address
P.O. Box 778
Sugar Grove, IL 60554-5429
Phone (630) 803-4711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-54690-1 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363824000000",
"number": "1689916223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 778",
"city": "SUGAR GROVE",
"state": "IL",
"postal_code": "605545429",
"telephone_number": "630-803-4711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 TERRY DR",
"city": "SUGAR GROVE",
"state": "IL",
"postal_code": "605545429",
"telephone_number": "630-803-4711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKALETSKY",
"first_name": "GARY",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-21",
"last_updated": "2013-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "036-54690-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sugar Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.