Healthcare Provider Details

I. General information

NPI: 1194960807
Provider Name (Legal Business Name): KEITH M RAMSEY MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7863 BROADWAY STE 244
MERRILLVILLE IN
46410-5553
US

IV. Provider business mailing address

1512 BURR ST
GARY IN
46406-2369
US

V. Phone/Fax

Practice location:
  • Phone: 773-991-3602
  • Fax: 219-962-5058
Mailing address:
  • Phone: 219-944-3933
  • Fax: 219-944-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number01036485A
License Number StateIN

VIII. Authorized Official

Name: MS. KIM BLACKMON
Title or Position: ACCOUNTANT
Credential:
Phone: 219-545-3423