Provider Demographics
NPI:1952331613
Name:URREA, RAMON E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:E
Last Name:URREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMON
Other - Middle Name:E
Other - Last Name:URREA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:955 S BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-9701
Mailing Address - Country:US
Mailing Address - Phone:269-639-2777
Mailing Address - Fax:269-639-2776
Practice Address - Street 1:965 S BAILEY AVE
Practice Address - Street 2:SUITE 1-4
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9701
Practice Address - Country:US
Practice Address - Phone:269-639-2777
Practice Address - Fax:269-639-2776
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063714207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4135897T10Medicaid
MI38-1676780OtherEIM
MI38-1676780OtherEIM
H06924Medicare UPIN
MI0H06003Medicare PIN
MI0H06003033Medicare ID - Type Unspecified