Provider Demographics
NPI:1306408349
Name:DESIR, RALPH EMMANUEL (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EMMANUEL
Last Name:DESIR
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 S STATE ST APT 19-G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3108
Mailing Address - Country:US
Mailing Address - Phone:305-527-2544
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 118
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3817
Practice Address - Country:US
Practice Address - Phone:312-942-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.075269208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation