Basic Information
| Provider Information | |||||||||
| NPI: | 1588661656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHALY | ||||||||
| FirstName: | RAMSIS | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 967 | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604770967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085326029 | ||||||||
| FaxNumber: | 7085326095 | ||||||||
| Practice Location | |||||||||
| Address1: | 4260 WESTBROOK DR | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605048136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309786793 | ||||||||
| FaxNumber: | 6305183599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 036-076877 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207T00000X | 036076877 | IL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207L00000X | 036076877 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 216082001 | 01 | IL | MEDICARE | OTHER | 036076877 | 05 | IL | MEDICAID |