Provider Demographics
NPI:1831197995
Name:JAZAYERLI, RANY (MD)
Entity type:Individual
Prefix:DR
First Name:RANY
Middle Name:
Last Name:JAZAYERLI
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 1:2560 FOXFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5797
Mailing Address - Country:US
Mailing Address - Phone:630-443-8855
Mailing Address - Fax:630-443-8866
Practice Address - Street 1:2560 FOXFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5797
Practice Address - Country:US
Practice Address - Phone:630-443-8855
Practice Address - Fax:630-443-8866
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108686207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108686Medicaid
IL04532208OtherBLUE CROSS BLUE SHEILD
ILH83109Medicare UPIN
ILK12383Medicare ID - Type Unspecified