Provider Demographics
NPI:1386053759
Name:PRUDENCIO, RAMIRO FELIX (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIRO
Middle Name:FELIX
Last Name:PRUDENCIO
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 1:1200 BROADMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3707
Mailing Address - Country:US
Mailing Address - Phone:847-441-5558
Mailing Address - Fax:
Practice Address - Street 1:1200 BROADMEADOW RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-3707
Practice Address - Country:US
Practice Address - Phone:847-441-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.042372208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology