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NPI Code Detail

MEDICARE: RANILO JOHN RABACAL MD

MEDICARE: RANILO JOHN RABACAL MD
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
1207Q00000XFamily Medicine Physician4301090735MI
2207Q00000XFamily Medicine Physician036-124828IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396930590
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANILO JOHN RABACAL MD
Provider Business Mailing Address
First Line : 635 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4618
Country : US
Telephone Number : 312-694-2273
Fax Number : 312-694-2129
Provider Business Practice Location Address
First Line : 635 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4618
Country : US
Telephone Number : 312-694-2273
Fax Number : 312-694-2129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2007
Last Update Date : 07/21/2022

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