MEDICARE: TIMOTHY RAMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34662	MN

General Provider Information

NPI Number	:	1053324418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RAMER MD

Provider Business Mailing Address
First Line	:	2020 E 28TH ST
Second Line	:	SMILEY'S CLINIC
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1394
Country	:	US
Telephone Number	:	612-333-0770
Fax Number	:	612-333-1986

Provider Business Practice Location Address
First Line	:	2020 E 28TH ST
Second Line	:	SMILEY'S CLINIC
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1394
Country	:	US
Telephone Number	:	612-333-0770
Fax Number	:	612-359-0475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	09/13/2011

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