Provider Demographics
NPI:1477618155
Name:DEGANI, OMAIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAIMA
Middle Name:
Last Name:DEGANI
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:1425 N HUNT CLUB RD STE 301
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2639
Practice Address - Country:US
Practice Address - Phone:847-855-9152
Practice Address - Fax:847-855-5152
Is Sole Proprietor?:No
Enumeration Date:2006-12-24
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117127207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215049Medicare ID - Type Unspecified
IL172078Medicare UPIN