Basic Information
Provider Information | |||||||||
NPI: | 1073509451 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YOCKEY | ||||||||
FirstName: | RANAE | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 880 W CENTRAL RD STE 6200 | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON HEIGHTS | ||||||||
State: | IL | ||||||||
PostalCode: | 600052378 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476180730 | ||||||||
FaxNumber: | 8476180799 | ||||||||
Practice Location | |||||||||
Address1: | 880 W CENTRAL RD STE 6200 | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON HEIGHTS | ||||||||
State: | IL | ||||||||
PostalCode: | 600052378 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476180730 | ||||||||
FaxNumber: | 8476180799 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/21/2005 | ||||||||
LastUpdateDate: | 05/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: | 03/24/2006 | ||||||||
NPIReactivationDate: | 09/27/2007 | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036089219 | IL | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 0001628269 | 01 | IL | BC/BS OF IL | OTHER | 2808142 | 01 | IL | AETNA | OTHER | 036089219 | 01 | IL | STATE LICENSE | OTHER |