Healthcare Provider Details

I. General information

NPI: 1063945608
Provider Name (Legal Business Name): LAURA LORENA VIRGEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LORENA RAMIREZ

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST STE 1128M
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 312-609-0300
  • Fax: 708-684-3070
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.014397
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036179035
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: