Provider Demographics
NPI:1184775264
Name:RAMZA, JUSTIN TODD (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TODD
Last Name:RAMZA
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 1:4140 OLD GOLF RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-7630
Mailing Address - Country:US
Mailing Address - Phone:815-988-9885
Mailing Address - Fax:
Practice Address - Street 1:2028 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4804
Practice Address - Country:US
Practice Address - Phone:815-282-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210693OtherMEDICARE GROUP NUMBER
ILK41341Medicare PIN