Healthcare Provider Details

I. General information

NPI: 1396957437
Provider Name (Legal Business Name): OHAD RONEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST PAV-3A158
SPRINGFIELD IL
62701
US

IV. Provider business mailing address

PO BOX 19662
SPRINGFIELD IL
62794-9662
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8853
  • Fax: 217-545-0828
Mailing address:
  • Phone: 217-545-8853
  • Fax: 217-545-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: