Provider Demographics
NPI:1063611895
Name:GHEITH, RAMIS (MD)
Entity type:Individual
Prefix:
First Name:RAMIS
Middle Name:
Last Name:GHEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3891
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-3891
Mailing Address - Country:US
Mailing Address - Phone:636-933-2243
Mailing Address - Fax:
Practice Address - Street 1:12255 DE PAUL DR STE 120
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2513
Practice Address - Country:US
Practice Address - Phone:636-933-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-076787207L00000X
IL036115525208VP0000X
MO2008003901208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008003901OtherMO LICENSE
0333210001OtherDMERC
RO3578Medicare PIN
MOMA2360001Medicare PIN