Provider Demographics
NPI:1932173077
Name:SAGE, RONALD (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SAGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:101-1740 LOYOLA UNIVERSITY MEDICAL CENTER
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3280
Mailing Address - Fax:708-216-5858
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:101-1740 LOYOLA UNIVERSITY MEDICAL CENTER
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5825
Practice Address - Fax:708-216-3280
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16002933213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16002933Medicaid
ILL98024OtherMEDICARE
ILL98024OtherMEDICARE
T36957Medicare UPIN