Provider Demographics
NPI:1184715641
Name:PLA VARONA, RAMON JR (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:PLA VARONA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMON
Other - Middle Name:
Other - Last Name:PLA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 W MONROE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2420
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:10688 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5411
Practice Address - Country:US
Practice Address - Phone:216-682-7703
Practice Address - Fax:216-236-7768
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40450207R00000X
IL036 079717207R00000X
IL036 074432207R00000X
OH35.134915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074432Medicaid
OH35.134915OtherLICENSE
IL036074432Medicaid
IA203010020Medicare PIN