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NPI Code Detail

MEDICARE: DR. RONNIE RANJAN MANDAL D.O,MBA,MS,MT(ASCP)

MEDICARE: DR. RONNIE RANJAN MANDAL D.O,MBA,MS,MT(ASCP)
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
1207R00000XInternal Medicine Physician036119779IL
2208M00000XHospitalist Physician036119779IL

General Provider Information

NPI Number : 1104002872
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONNIE RANJAN MANDAL D.O,MBA,MS,MT(ASCP)
Provider Business Mailing Address
First Line : 5115 N FRANCISCO AVE
Second Line : FL 1
City : CHICAGO
State : IL
Zip : 60625-3611
Country : US
Telephone Number : 773-271-6622
Fax Number : 773-271-6801
Provider Business Practice Location Address
First Line : 5115 N FRANCISCO AVE
Second Line : FL 1
City : CHICAGO
State : IL
Zip : 60625-3611
Country : US
Telephone Number : 773-271-6622
Fax Number : 773-271-6801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2008
Last Update Date : 04/07/2021

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