Provider Demographics
NPI:1700805611
Name:RAMIREZ, ANTONIO MARIA (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MARIA
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N MAIN ST
Mailing Address - Street 2:PO BOX 372
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1785
Mailing Address - Country:US
Mailing Address - Phone:815-875-6001
Mailing Address - Fax:815-875-3612
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1785
Practice Address - Country:US
Practice Address - Phone:815-875-6001
Practice Address - Fax:815-875-3612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075824Medicaid
1023186517OtherORGANIZATION IDENTIFIER #
IL00600116OtherBLUE CROSS BLUE SHIELD
IL00600116OtherBLUE CROSS BLUE SHIELD
1023186517OtherORGANIZATION IDENTIFIER #
1700805611Medicare ID - Type UnspecifiedNPI
IL050034636Medicare ID - Type UnspecifiedRAILROAD MEDICARE