Basic Information
| Provider Information | |||||||||
| NPI: | 1770568362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMSEY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 16000 W 101ST AVE | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463113046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193656333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16000 W 101ST AVE | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463113046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193656333 | ||||||||
| FaxNumber: | 2193658291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036063369 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 02000963 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 02000963A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 100338360 | 05 | IN | MEDICAID | 000000095314 | 01 | IN | ANTHEM PIN | OTHER | 060030167 | 01 | RR MEDICARE | OTHER |