Provider Demographics
NPI:1699806968
Name:JOAQUIN, ALICIA RAMOS (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RAMOS
Last Name:JOAQUIN
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 1:300 N STATE ST
Mailing Address - Street 2:SUITE 4124
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5414
Mailing Address - Country:US
Mailing Address - Phone:312-371-3287
Mailing Address - Fax:312-670-0829
Practice Address - Street 1:300 N STATE ST
Practice Address - Street 2:SUITE 4124
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5414
Practice Address - Country:US
Practice Address - Phone:312-371-3287
Practice Address - Fax:312-670-0829
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3Medicaid
IL3Medicaid