Provider Demographics
NPI:1932249638
Name:MEDHAT, RAMIN A (DDS)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:A
Last Name:MEDHAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4709
Mailing Address - Country:US
Mailing Address - Phone:773-774-4611
Mailing Address - Fax:773-774-3973
Practice Address - Street 1:6011 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4709
Practice Address - Country:US
Practice Address - Phone:773-774-4611
Practice Address - Fax:773-774-3973
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice