Provider Demographics
NPI:1669708194
Name:RAMOS, IBELIS (LMT)
Entity type:Individual
Prefix:
First Name:IBELIS
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 N AUSTIN AVE
Mailing Address - Street 2:1ST FLOOR FRONT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5127
Mailing Address - Country:US
Mailing Address - Phone:773-255-8433
Mailing Address - Fax:
Practice Address - Street 1:3144 N AUSTIN AVE
Practice Address - Street 2:1ST FLOOR FRONT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5127
Practice Address - Country:US
Practice Address - Phone:773-255-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.009624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist