MEDICARE: DR. MARK ROMANELLI 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	125.057587	IL

General Provider Information

NPI Number	:	1164743787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ROMANELLI M.D.

Provider Business Mailing Address
First Line	:	1333 W BELMONT AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60657-5785
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 W BELMONT AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60657-5785
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:	312-694-1885

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	02/10/2015

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Directions to “ DR. MARK ROMANELLI M.D.” Practice Location

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