Provider Demographics
NPI:1417211780
Name:DERANI, LENA (MD)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:
Last Name:DERANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 W 56TH CT
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7325
Mailing Address - Country:US
Mailing Address - Phone:248-808-2057
Mailing Address - Fax:
Practice Address - Street 1:11824 SOUTHWEST HWY STE 100
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1083
Practice Address - Country:US
Practice Address - Phone:708-361-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100786207R00000X
IL036.1403212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine