Provider Demographics
NPI:1609997998
Name:ORTIZ-FERRER, LISSETTE CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:CARMEN
Last Name:ORTIZ-FERRER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:BUILDING 101, ROOM 1752
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:708-216-6269
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:BUILDING 101, ROOM 1752
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:708-216-6269
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-093739207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77746Medicare UPIN