Provider Demographics
NPI:1508387200
Name:RAMIREZ, LIONEL (MD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
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 1:6720 S FLORIDA AVE APT 2207
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3335
Mailing Address - Country:US
Mailing Address - Phone:787-309-5509
Mailing Address - Fax:
Practice Address - Street 1:5425 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2523
Practice Address - Country:US
Practice Address - Phone:863-644-3585
Practice Address - Fax:863-644-3171
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22008208D00000X
FLACN1333208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice