Healthcare Provider Details

I. General information

NPI: 1720023617
Provider Name (Legal Business Name): RONALD REMBERT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W. 155TH ST,
HARVEY IL
60426
US

IV. Provider business mailing address

31 W 155TH ST
HARVEY IL
60426-3556
US

V. Phone/Fax

Practice location:
  • Phone: 708-596-5177
  • Fax: 708-339-3583
Mailing address:
  • Phone: 708-596-5177
  • Fax: 708-339-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036108881
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: