Healthcare Provider Details

I. General information

NPI: 1811418411
Provider Name (Legal Business Name): JOSEAN RAMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

1446 N DEARBORN ST APT 4B
CHICAGO IL
60610-1581
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-7679
  • Fax:
Mailing address:
  • Phone: 312-684-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125071304
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number036152687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: