Healthcare Provider Details

I. General information

NPI: 1669510145
Provider Name (Legal Business Name): RANULFO CABRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST EAST TOWER, SUITE 463
EVANSTON IL
60202-3439
US

IV. Provider business mailing address

800 AUSTIN ST EAST TOWER, SUITE 463
EVANSTON IL
60202-3439
US

V. Phone/Fax

Practice location:
  • Phone: 847-475-8711
  • Fax: 847-475-2513
Mailing address:
  • Phone: 847-475-8711
  • Fax: 847-475-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: