Provider Demographics
NPI:1083939987
Name:RANZER, MATTHEW JARED (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JARED
Last Name:RANZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S WOOD ST
Mailing Address - Street 2:SUITE 515 CSN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-9313
Mailing Address - Fax:312-413-0495
Practice Address - Street 1:820 S WOOD ST
Practice Address - Street 2:SUITE 515 CSN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-9313
Practice Address - Fax:312-413-0495
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361297242086S0122X
MA244623208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF00217576Medicare PIN