Provider Demographics
NPI:1346204260
Name:MANGLANO, RAMON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:MANGLANO
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:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60690-0720
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:2320 HIGH ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2426
Practice Address - Country:US
Practice Address - Phone:708-388-5500
Practice Address - Fax:708-388-5672
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079265208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL324350OtherLOCALITY 16
ILIL3596004OtherLOCALITY 15
IL036079265Medicaid
IL020036556OtherRAILROAD MEDICARE
IL020036556OtherRAILROAD MEDICARE
IL036079265Medicaid
ILF53732Medicare UPIN
ILIL3596004OtherLOCALITY 15