Provider Demographics
NPI:1821298555
Name:RAMMOS, CHARALAMBOS KYRIAKOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARALAMBOS
Middle Name:KYRIAKOS
Last Name:RAMMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 N EXECUTIVE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4896
Mailing Address - Country:US
Mailing Address - Phone:309-670-0951
Mailing Address - Fax:309-670-0733
Practice Address - Street 1:4911 N EXECUTIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4896
Practice Address - Country:US
Practice Address - Phone:309-670-0951
Practice Address - Fax:309-670-0733
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1061772086S0122X
IL125053834208600000X
MN557592086S0122X
IL36.129302208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240000406Medicare PIN