Provider Demographics
NPI:1134328719
Name:HAMMOUD, RAMADAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMADAN
Middle Name:
Last Name:HAMMOUD
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 1:360 STATION DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8003
Mailing Address - Country:US
Mailing Address - Phone:815-344-3900
Mailing Address - Fax:815-356-2388
Practice Address - Street 1:360 STATION DR STE 300
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8003
Practice Address - Country:US
Practice Address - Phone:815-344-3900
Practice Address - Fax:815-356-2388
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11188207RE0101X
IL036157760207RE0101X
FLME126561207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116350400Medicaid
MI0M74460376Medicare PIN