Provider Demographics
NPI:1548642069
Name:ANTOINE, RANAE DINA ARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:RANAE
Middle Name:DINA ARLENE
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 MADISON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4210
Mailing Address - Country:US
Mailing Address - Phone:708-486-2700
Mailing Address - Fax:708-486-2702
Practice Address - Street 1:101 MADISON ST STE 3
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-486-2700
Practice Address - Fax:708-486-2702
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.144571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program