Healthcare Provider Details

I. General information

NPI: 1962399071
Provider Name (Legal Business Name): RAMEEN USMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 GREEN BAY RD STE 112
KENOSHA WI
53142-2948
US

IV. Provider business mailing address

34015 N WOODED GLEN DR
GRAYSLAKE IL
60030-4022
US

V. Phone/Fax

Practice location:
  • Phone: 262-653-3980
  • Fax:
Mailing address:
  • Phone: 847-897-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001879
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: