MEDICARE: DR. RANY JAZAYERLI M.D.

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	207N00000X	Dermatology Physician	036108686	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	04532208	OTHER	IL	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1831197995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANY JAZAYERLI M.D.

Provider Business Mailing Address
First Line	:	2560 FOXFIELD RD
Second Line	:	SUITE 100
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-5797
Country	:	US
Telephone Number	:	630-443-8855
Fax Number	:	630-443-8866

Provider Business Practice Location Address
First Line	:	2560 FOXFIELD RD
Second Line	:	SUITE 100
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-5797
Country	:	US
Telephone Number	:	630-443-8855
Fax Number	:	630-443-8866

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/23/2013

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