Provider Demographics
NPI:1326116104
Name:SENNO, RICARDO GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:GABRIEL
Last Name:SENNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-644-8242
Mailing Address - Fax:847-272-8221
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-644-8242
Practice Address - Fax:847-272-8221
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099306208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363236791OtherTAX ID #
IL036099306Medicaid
ILH20603Medicare UPIN
IL036099306Medicaid
ILK25178Medicare ID - Type Unspecified