MEDICARE: DR. MARY C. RANIELI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1528184629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY C. RANIELI DDS

Provider Business Mailing Address
First Line	:	PO BOX 66414
Second Line	:	O'HARE INTERNATIONAL AIRPORT-HILTON ARCADE LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60666-0414
Country	:	US
Telephone Number	:	773-601-8900
Fax Number	:	773-601-8988

Provider Business Practice Location Address
First Line	:	11601 WEST TOUHY AVENUE
Second Line	:	O'HARE INTERNATIONAL AIRPORT-HILTON ARCADE LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60666
Country	:	US
Telephone Number	:	773-601-8900
Fax Number	:	773-601-8988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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