Provider Demographics
NPI:1417104274
Name:DE RANIERI, DEIRDRE ITA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:ITA
Last Name:DE RANIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEIRDRE
Other - Middle Name:ITA
Other - Last Name:GARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2216 N MAGNOLIA AVE FRNT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3104
Mailing Address - Country:US
Mailing Address - Phone:857-205-7461
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC5044
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1280272080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology