Basic Information
| Provider Information | |||||||||
| NPI: | 1902010911 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL A. RAMOS, MD., PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 W 13TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810033761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195448250 | ||||||||
| FaxNumber: | 7195447518 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 W 13TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810033761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195448250 | ||||||||
| FaxNumber: | 7195447518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7195448250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | RA35174 | 01 | BCBS | OTHER | 01276120 | 05 | CO | MEDICAID |