MEDICARE: DR. SAMUEL RAMIREZ D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016004751	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480027231	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01607718	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649237702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL RAMIREZ D.P.M.

Provider Business Mailing Address
First Line	:	4918 N MAGNOLIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3507
Country	:	US
Telephone Number	:	773-728-0989
Fax Number	:	773-728-1062

Provider Business Practice Location Address
First Line	:	5723 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2306
Country	:	US
Telephone Number	:	773-622-8060
Fax Number	:	773-622-8095

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. SAMUEL RAMIREZ D.P.M.” Practice Location

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