Provider Demographics
NPI:1114922101
Name:COLON-RAMOS, LIZZETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZZETTE
Middle Name:
Last Name:COLON-RAMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIZZETTE
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10917 E AMINOFF DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4489
Mailing Address - Country:US
Mailing Address - Phone:217-881-9059
Mailing Address - Fax:217-881-9059
Practice Address - Street 1:1901 S 4TH ST, STE 21
Practice Address - Street 2:VA EFFINGHAM CBOC
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4489
Practice Address - Country:US
Practice Address - Phone:217-347-7600
Practice Address - Fax:217-342-9733
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8062207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81831Medicare ID - Type Unspecified
PRE63006Medicare UPIN