Provider Demographics
NPI:1851603658
Name:RAMIREZ, GLENDA L (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:L
Last Name:RAMIREZ
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 1:310 W MICHIGAN ST APT 233
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3231
Mailing Address - Country:US
Mailing Address - Phone:317-260-1111
Mailing Address - Fax:
Practice Address - Street 1:310 W MICHIGAN ST APT 233
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3231
Practice Address - Country:US
Practice Address - Phone:317-948-1310
Practice Address - Fax:317-948-0503
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074918A208M00000X, 207R00000X
VA0101255110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201314060Medicaid
IN068010162Medicare PIN
IN201314060Medicaid