Provider Demographics
NPI:1396930590
Name:RABACAL, RANILO JOHN (MD)
Entity type:Individual
Prefix:
First Name:RANILO
Middle Name:JOHN
Last Name:RABACAL
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 1:635 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4618
Mailing Address - Country:US
Mailing Address - Phone:312-694-2273
Mailing Address - Fax:312-694-2129
Practice Address - Street 1:635 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4618
Practice Address - Country:US
Practice Address - Phone:312-694-2273
Practice Address - Fax:312-694-2129
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090735207Q00000X
IL036-124828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1396930590Medicaid
IA1396930590Medicaid