Healthcare Provider Details

I. General information

NPI: 1093751075
Provider Name (Legal Business Name): DEBRA ANN RITA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

PO BOX 92710
CHICAGO IL
60675-0001
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-7705
  • Fax: 847-723-8675
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036065740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: