Provider Demographics
NPI:1861459364
Name:RAMIREZ, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
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 1:1500 EAGLE RIDGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3228
Mailing Address - Country:US
Mailing Address - Phone:219-237-2079
Mailing Address - Fax:219-595-5377
Practice Address - Street 1:1500 EAGLE RIDGE DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-237-2079
Practice Address - Fax:219-595-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055919208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200397690Medicaid
H67130Medicare UPIN
IN499500 ZZMedicare PIN