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General NPI Number Information
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NPI Number | 1124341458
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Entity Type | Organization
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Legal Business Name | RAMJAC CORP INC
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 2530 CRAWFORD AVE STE 104
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City | EVANSTON
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State | IL
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Zip | 60201-4954
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Country | US
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Telephone | 847-559-9345
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Fax | 847-559-9225
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Provider Business Mailing Address
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Address Line | 1015 WILLOW RD
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City | WINNETKA
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State | IL
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Zip | 60093-3636
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Country | US
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Telephone | 847-559-9345
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Fax | 847-559-9225
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN RICHARD CANN
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Credential | M.D.
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Telephone | 847-559-9345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036055232
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License Number State | IL
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