=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043394729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH RAMSEY UNAL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 12/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 N 9TH ST STE 6W100
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62702-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-545-5117
-----------------------------------------------------
Fax | 217-545-4912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 19640
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62794-9640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-545-5117
-----------------------------------------------------
Fax | 217-545-4912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 036118417
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VM0101X
-----------------------------------------------------
Taxonomy Name | Maternal & Fetal Medicine Physician
-----------------------------------------------------
License Number | 036-118417
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------