NPIMap

Individual provider Active NPI

Raneem R Sheblak, DDS

  • Dentist
  • Blue Island, IL
National Provider Identifier
1841551595
Registry record updated Nov 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.028866 Issued in IL
Practice address
12200 Western Ave
Suite 108
Blue Island, IL 60406-1398
Phone
(708) 385-3700
NPI assigned
May 30, 2012
Last updated
Nov 18, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019.028866 IL Primary

Addresses

Primary practice location

12200 Western Ave
Suite 108
Blue Island, IL 60406-1398

Mailing address

12200 Western Ave
Suite 108
Blue Island, IL 60406-1398
Phone (708) 269-0284

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
019.028866ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Experts, LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353196800000",
    "number": "1841551595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 WESTERN AVE",
            "address_2": "SUITE 108",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061398",
            "telephone_number": "708-269-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 WESTERN AVE",
            "address_2": "SUITE 108",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061398",
            "telephone_number": "708-385-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEBLAK",
        "first_name": "RANEEM",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-30",
        "last_updated": "2012-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.028866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Island, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.