Provider Demographics
NPI:1215042528
Name:RAMIREZ, ROBERTO P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:P
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-942-7998
Mailing Address - Fax:
Practice Address - Street 1:16660 107TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8898
Practice Address - Country:US
Practice Address - Phone:708-403-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092880Medicaid
IL036092880Medicaid
IL0001616367OtherBLUE CROSS BLUE SHIELD
IL0040147400OtherBLUE CHOICE
G43610Medicare UPIN
362664182OtherCIGNA
362664182OtherHUMANA
IL036092880Medicaid
0005174572OtherAETNA
110148410OtherRR MEDICARE