Healthcare Provider Details

I. General information

NPI: 1831197995
Provider Name (Legal Business Name): RANY JAZAYERLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 FOXFIELD RD SUITE 100
SAINT CHARLES IL
60174-5797
US

IV. Provider business mailing address

2560 FOXFIELD RD SUITE 100
SAINT CHARLES IL
60174-5797
US

V. Phone/Fax

Practice location:
  • Phone: 630-443-8855
  • Fax: 630-443-8866
Mailing address:
  • Phone: 630-443-8855
  • Fax: 630-443-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036108686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: