MEDICARE: JOANNE NIERE-RAMOS M.D.

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	207Q00000X	Family Medicine Physician	01078626A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	01078626A	IN

General Provider Information

NPI Number	:	1851702229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE NIERE-RAMOS M.D.

Provider Business Mailing Address
First Line	:	2241 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2601
Country	:	US
Telephone Number	:	219-922-8051
Fax Number	:	219-922-8608

Provider Business Practice Location Address
First Line	:	6625 W LINCOLN HWY
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9678
Country	:	US
Telephone Number	:	219-922-8051
Fax Number	:	219-922-8608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	09/22/2020

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