Healthcare Provider Details

I. General information

NPI: 1548216435
Provider Name (Legal Business Name): JUAN CARLOS CAICEDO RAMIREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST GALTER 17-200
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1000
CHICAGO IL
60611-8709
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8900
  • Fax: 312-695-9194
Mailing address:
  • Phone: 312-695-8900
  • Fax: 312-695-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number036115147
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-1151417
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: