Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301091728 | MI |
N | 111NI0900X | Internist | 4301091728 | MI |
N | 207RH0000X | Hematologist | 036135830 | IL |
Y | 207RH0003X | Hematology & Oncology | 036135830 | IL |
NPI | 1083863310 |
---|---|
Provider Name | Andrea Renata Dean |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 09/07/2019 |