Healthcare Provider Details

I. General information

NPI: 1326496449
Provider Name (Legal Business Name): RAM PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E DELAWARE PL SUITE 1430
CHICAGO IL
60611-1998
US

IV. Provider business mailing address

60 E DELAWARE PL SUITE 1430
CHICAGO IL
60611-1998
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-3010
  • Fax: 312-337-7798
Mailing address:
  • Phone: 312-337-3010
  • Fax: 312-337-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036-128420
License Number StateIL

VIII. Authorized Official

Name: RAMSEN AZIZI
Title or Position: OWNER
Credential: MD
Phone: 312-337-3010