Provider Demographics
NPI:1689763419
Name:MARQUEZ, RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 N 2ND ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3276
Mailing Address - Country:US
Mailing Address - Phone:815-217-0155
Mailing Address - Fax:815-217-0185
Practice Address - Street 1:147 N 2ND ST
Practice Address - Street 2:SUITE #7
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3276
Practice Address - Country:US
Practice Address - Phone:815-217-0155
Practice Address - Fax:815-217-0185
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361166922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116692Medicaid
IL036116692Medicaid