MEDICARE: RAMI MIKATI

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	1223P0221X	Pediatric Dentistry	021002918	IL

General Provider Information

NPI Number	:	1285096867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMI MIKATI

Provider Business Mailing Address
First Line	:	1249 W MADISON ST UNIT 305
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 S WALLACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3034
Country	:	US
Telephone Number	:	312-326-5437
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	07/01/2019

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Directions to “ RAMI MIKATI ” Practice Location

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