Provider Demographics
NPI:1770524043
Name:FIORE, RALPH II (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:FIORE
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 264
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3844
Mailing Address - Country:US
Mailing Address - Phone:312-942-2195
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 264
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3844
Practice Address - Country:US
Practice Address - Phone:312-942-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.131170207N00000X
WI64521-21207N00000X
MS22926207N00000X
IL125055964208D00000X
WI1630-023363A00000X
IL085-001825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q12877Medicare UPIN
WI029050151Medicare PIN
P00173570Medicare PIN
208614Medicare PIN
CD0278Medicare PIN
WI014730092Medicare PIN
K12294Medicare PIN
DB9340Medicare PIN