Provider Demographics
NPI:1386659001
Name:RAMIRO, SUSAN B (MD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:RAMIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:RAMIRO-TOLENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61555-1186
Mailing Address - Country:US
Mailing Address - Phone:309-353-4483
Mailing Address - Fax:309-353-7713
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:ST FRANCIS MEDICAL CENTER
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-655-2485
Practice Address - Fax:309-655-2874
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL48713208000000X
IL29942080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03609161803Medicaid
IL004082OtherHEALTH ALLIANCE
ILIL0108OtherJOHN DEERE
IL7215111OtherBLUE CROSS BLUE SHIELD