Provider Demographics
NPI:1780849976
Name:DERANJA, EVAN OWEN FOSTER (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:OWEN FOSTER
Last Name:DERANJA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MIDWEST RD STE 202
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1368
Mailing Address - Country:US
Mailing Address - Phone:331-222-7985
Mailing Address - Fax:
Practice Address - Street 1:2021 MIDWEST RD STE 202
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1368
Practice Address - Country:US
Practice Address - Phone:331-222-7985
Practice Address - Fax:331-204-0796
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2527752084P0800X
IL0361358732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry