Provider Demographics
NPI:1578191391
Name:RENZ, ANDIA MITRI (MD)
Entity type:Individual
Prefix:
First Name:ANDIA
Middle Name:MITRI
Last Name:RENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W 75TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-596-8045
Mailing Address - Fax:630-590-9634
Practice Address - Street 1:1331 W 75TH ST STE 402
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9311
Practice Address - Country:US
Practice Address - Phone:630-596-8045
Practice Address - Fax:630-590-9634
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036174023207N00000X
NY32930901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology