Healthcare Provider Details

I. General information

NPI: 1124178330
Provider Name (Legal Business Name): RAMON A GARCIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 W FULLERTON AVE
CHICAGO IL
60647-2443
US

IV. Provider business mailing address

3538 W FULLERTON AVE
CHICAGO IL
60647-2443
US

V. Phone/Fax

Practice location:
  • Phone: 773-772-1212
  • Fax: 773-772-8666
Mailing address:
  • Phone: 773-772-1212
  • Fax: 773-772-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number042 006331
License Number StateIL

VIII. Authorized Official

Name: DR. RAMON ANDRES GARCIA JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 773-772-1212