Provider Demographics
NPI:1639281512
Name:RAMOS, LOURDES DE LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:DE LEON
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 MISSISSIPPI LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2941
Mailing Address - Country:US
Mailing Address - Phone:847-352-0537
Mailing Address - Fax:
Practice Address - Street 1:21W480 ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1404
Practice Address - Country:US
Practice Address - Phone:630-932-1870
Practice Address - Fax:630-932-8191
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0032242798OtherBCBS OF IL
IL036110213Medicaid