Provider Demographics
NPI:1730125097
Name:CLEMENTE, RONALD JOSEPH (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:CLEMENTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W WISE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3777
Mailing Address - Country:US
Mailing Address - Phone:847-352-0200
Mailing Address - Fax:847-352-0600
Practice Address - Street 1:1015 W WISE RD
Practice Address - Street 2:STE 101
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3777
Practice Address - Country:US
Practice Address - Phone:847-352-0200
Practice Address - Fax:847-352-0600
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002780213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480028503OtherRAILROAD MEDICARE
IL0060000949OtherBCBS
IL480028503OtherRAILROAD MEDICARE
IL0797260001Medicare NSC
IL521780Medicare ID - Type Unspecified