Healthcare Provider Details

I. General information

NPI: 1023299880
Provider Name (Legal Business Name): AMY RAMIREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S WENTWORTH AVE
CHICAGO IL
60609-6300
US

IV. Provider business mailing address

5401 S WENTWORTH AVE
CHICAGO IL
60609-6300
US

V. Phone/Fax

Practice location:
  • Phone: 773-288-6900
  • Fax: 773-268-3020
Mailing address:
  • Phone: 773-288-6900
  • Fax: 773-268-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-065247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: