Healthcare Provider Details

I. General information

NPI: 1558527069
Provider Name (Legal Business Name): EILEEN C. DEANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 REBA CT
MORTON GROVE IL
60053-3342
US

IV. Provider business mailing address

11 REBA CT
MORTON GROVE IL
60053-3342
US

V. Phone/Fax

Practice location:
  • Phone: 847-722-1251
  • Fax:
Mailing address:
  • Phone: 847-722-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63105-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number63105-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: