Provider Demographics
NPI:1043226863
Name:RAMONA I SLUPIK MD SC
Entity Type:Organization
Organization Name:RAMONA I SLUPIK MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:I
Authorized Official - Last Name:SLUPIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-202-0551
Mailing Address - Street 1:1 E ERIE ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2740
Mailing Address - Country:US
Mailing Address - Phone:312-202-0551
Mailing Address - Fax:312-397-9601
Practice Address - Street 1:1 E ERIE ST
Practice Address - Street 2:SUITE 530
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:312-202-0551
Practice Address - Fax:312-397-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01625685OtherBC/BS PROVIDER #
IL209363Medicare PIN
ILD15233Medicare UPIN