Provider Demographics
NPI:1265489462
Name:RIETI, ANABELA (DPM)
Entity Type:Individual
Prefix:
First Name:ANABELA
Middle Name:
Last Name:RIETI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HUEHL RD
Mailing Address - Street 2:UNIT #13
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2319
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:847-504-5015
Practice Address - Street 1:425 HUEHL RD
Practice Address - Street 2:UNIT #13
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000995A213E00000X
IL016005262213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005262Medicaid
IN200803940AMedicaid
07322240001OtherDMERC # WITH PPG
ILP00735379Medicare PIN
07322240001OtherDMERC # WITH PPG
IN859800WMedicare PIN
IL016005262Medicaid
ILR00539Medicare PIN
ILF400118637Medicare PIN
IL016005262Medicaid