MEDICARE: RAYMOND SAMUEL BIANCHI 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	207Q00000X	Family Medicine Physician	036073025	IL

General Provider Information

NPI Number	:	1114916558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND SAMUEL BIANCHI M.D.

Provider Business Mailing Address
First Line	:	290 N RAND RD
Second Line	:	SUITE A
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	847-438-4028
Fax Number	:	847-438-2462

Provider Business Practice Location Address
First Line	:	290 N RAND RD
Second Line	:	SUITE A
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	847-438-4028
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	03/22/2010

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