Provider Demographics
NPI:1952494825
Name:RAMIREZ-ICAZA, CARLOS JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:RAMIREZ-ICAZA
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:1225 S BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4568
Practice Address - Fax:859-258-4698
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38093207R00000X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200245580Medicaid
KYP00091108OtherRR MEDICARE
IN200245580Medicaid
KY00149002Medicare PIN
IN258300BMedicare PIN
KYP00091108OtherRR MEDICARE
KY00150002Medicare PIN
KY1200913Medicare PIN
KY0791201Medicare PIN