Healthcare Provider Details

I. General information

NPI: 1770568362
Provider Name (Legal Business Name): KENNETH J RAMSEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 KEILMAN ST FL 2
SAINT JOHN IN
46373-9406
US

IV. Provider business mailing address

PO BOX 1076
CROWN POINT IN
46308-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-699-0122
  • Fax: 877-258-9910
Mailing address:
  • Phone: 219-662-3931
  • Fax: 219-663-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02000963
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02000963A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036063369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: