Healthcare Provider Details

I. General information

NPI: 1326692328
Provider Name (Legal Business Name): LENA RAMMOUNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date: 03/22/2024
Reactivation Date: 04/01/2024

III. Provider practice location address

4220 W 95TH ST STE 210
OAK LAWN IL
60453-2793
US

IV. Provider business mailing address

22212 DOXTATOR ST
DEARBORN MI
48128-1411
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-4200
  • Fax:
Mailing address:
  • Phone: 313-333-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125084183
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: