Provider Demographics
NPI:1770568362
Name:RAMSEY, KENNETH J (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:RAMSEY
Suffix:
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:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1076
Mailing Address - Country:US
Mailing Address - Phone:219-662-3931
Mailing Address - Fax:219-663-6359
Practice Address - Street 1:16000 W. 101ST AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-3046
Practice Address - Country:US
Practice Address - Phone:219-365-6333
Practice Address - Fax:877-258-9910
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063369207RC0000X
IN02000963207RC0000X
IN02000963A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060030167OtherRR MEDICARE
IN000000095314OtherANTHEM PIN
IN100338360Medicaid
060030167OtherRR MEDICARE
IN000000095314OtherANTHEM PIN
IN406090CMedicare PIN
IN100338360Medicaid