Provider Demographics
NPI:1932580644
Name:RIPA, MADELINE DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:DIANNE
Last Name:RIPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2914
Mailing Address - Country:US
Mailing Address - Phone:866-798-6633
Mailing Address - Fax:
Practice Address - Street 1:2640 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2914
Practice Address - Country:US
Practice Address - Phone:866-798-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11191801-1205207W00000X
IL125067960207W00000X
MO2015019310207W00000X
IL036.151523207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology