Provider Demographics
NPI:1235321704
Name:RANA, SAPANA H (DO)
Entity Type:Individual
Prefix:MS
First Name:SAPANA
Middle Name:H
Last Name:RANA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2219
Mailing Address - Country:US
Mailing Address - Phone:773-239-9100
Mailing Address - Fax:773-239-9102
Practice Address - Street 1:10961 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2219
Practice Address - Country:US
Practice Address - Phone:773-239-9100
Practice Address - Fax:773-239-9102
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1144214644OtherFACILITY NPI
IL036118973Medicaid
IL036118973Medicaid
ILK46083Medicare PIN