MEDICARE: RAMONA I SLUPIK MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036062636	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01625685	OTHER	IL	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1043226863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMONA I SLUPIK MD SC

Provider Business Mailing Address
First Line	:	1 E ERIE ST
Second Line	:	SUITE 530
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	312-202-0551
Fax Number	:	312-397-9601

Provider Business Practice Location Address
First Line	:	1 E ERIE ST
Second Line	:	SUITE 530
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	312-202-0551
Fax Number	:	312-397-9601

Authorized Official
Title or Position	:	OWNER
Name	:	RAMONA I SLUPIK
Credential	:	MD
Telephone Number	:	312-202-0551

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/23/2016

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