Healthcare Provider Details

I. General information

NPI: 1013910884
Provider Name (Legal Business Name): LAWRENCE D RAMUNNO MD, MPH, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 VALLEY DR
VALPARAISO IN
46383-2520
US

IV. Provider business mailing address

2401 VALLEY DR
VALPARAISO IN
46383-2520
US

V. Phone/Fax

Practice location:
  • Phone: 219-413-5100
  • Fax: 219-465-9507
Mailing address:
  • Phone: 219-413-5100
  • Fax: 219-465-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8376
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD042758
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number8376
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.160242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: