Healthcare Provider Details

I. General information

NPI: 1417104274
Provider Name (Legal Business Name): DEIRDRE ITA DE RANIERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIRDRE ITA GARRY M.D.

II. Dates (important events)

Enumeration Date: 08/24/2008
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 50
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

2216 N MAGNOLIA AVE FRNT
CHICAGO IL
60614-3104
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6270
  • Fax: 312-227-9417
Mailing address:
  • Phone: 857-205-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number036.128027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: