Healthcare Provider Details

I. General information

NPI: 1912959305
Provider Name (Legal Business Name): AMERICO MILAN RAMOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 N PAULINA ST SUITE 210
CHICAGO IL
60640-2772
US

IV. Provider business mailing address

5025 N PAULINA ST
CHICAGO IL
60640-2772
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-9040
  • Fax: 773-989-5406
Mailing address:
  • Phone: 773-271-9040
  • Fax: 773-989-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036083862
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036083862
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036083862
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: