Provider Demographics
NPI:1740817923
Name:RALPH, OLIVER
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:RALPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUSH UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:1750 W. HARRISON SUITE 775
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-5474
Mailing Address - Fax:
Practice Address - Street 1:RUSH UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:1750 W. HARRISON SUITE 775
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125075975208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery