Healthcare Provider Details

I. General information

NPI: 1205363710
Provider Name (Legal Business Name): DR. RANEEM RAJJOUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 GATEWAY DR STE 300
SYCAMORE IL
60178-3182
US

IV. Provider business mailing address

1630 GATEWAY DR STE 300
SYCAMORE IL
60178-3182
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-2587
  • Fax:
Mailing address:
  • Phone: 800-243-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.166093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: