1992089742 NPI number — MRS. KIMBERLY RAMIREZ-TASIGCHANA NP

Table of content: MRS. KIMBERLY RAMIREZ-TASIGCHANA NP (NPI 1992089742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992089742 NPI number — MRS. KIMBERLY RAMIREZ-TASIGCHANA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMIREZ-TASIGCHANA
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992089742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 MAIN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-962-4050
Provider Business Mailing Address Fax Number:
844-269-6718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2106 GRAND AVE
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
WAUKEGAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60085-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-381-7672
Provider Business Practice Location Address Fax Number:
844-269-6781
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209.009079 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1992089742 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com