Provider Demographics
NPI:1225115132
Name:TRANQUILLI, RITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:M
Last Name:TRANQUILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1761 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5846
Mailing Address - Country:US
Mailing Address - Phone:630-260-0606
Mailing Address - Fax:630-260-1049
Practice Address - Street 1:1761 S NAPERVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5846
Practice Address - Country:US
Practice Address - Phone:630-260-0606
Practice Address - Fax:630-260-1049
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360965382084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215643OtherBLUE CROSS
IL02215643OtherBLUE CROSS
ILCA2795Medicare PIN
IL02215643OtherBLUE CROSS
ILG05703Medicare UPIN
IL$$$$$$$$$Medicaid
IL586690Medicare PIN