Provider Demographics
NPI:1164530804
Name:GITELMAN, DARREN ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:ROSS
Last Name:GITELMAN
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 1:1875 DEMPSTER ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1130
Mailing Address - Country:US
Mailing Address - Phone:312-720-6464
Mailing Address - Fax:312-720-6463
Practice Address - Street 1:1875 DEMPSTER ST STE 520
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1130
Practice Address - Country:US
Practice Address - Phone:312-720-6464
Practice Address - Fax:312-720-6463
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360886382084N0400X
IL036-0886382084N0400X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF29191Medicare UPIN
IL349320Medicare ID - Type UnspecifiedMEDICARE NUMBER