Basic Information
Provider Information
NPI: 1336597863
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RANGNEKAR
FirstName: ISHAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2050 E ALGONQUIN RD STE 610
Address2:  
City: SCHAUMBURG
State: IL
PostalCode: 601734166
CountryCode: US
TelephoneNumber: 8889884066
FaxNumber: 8474964850
Practice Location
Address1: 142 E CAPITOL DR
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532121206
CountryCode: US
TelephoneNumber: 8889884066
FaxNumber: 8474964850
Other Information
ProviderEnumerationDate: 05/25/2016
LastUpdateDate: 05/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X1001293WIY Dental ProvidersDentist 

No ID Information.


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