Active NPI
Ramiro Felix Prudencio, M.D.
- Urology Physician
- Winnetka, IL
National Provider Identifier
1386053759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 036.042372
- Practice address
- 1200 Broadmeadow Rd
Winnetka, IL 60093-3707 - Phone
- (847) 441-5558
- NPI assigned
- Aug 10, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 036.042372 | IL | Primary |
Addresses
Primary practice location
1200 Broadmeadow Rd
Winnetka, IL 60093-3707
Mailing address
1200 Broadmeadow Rd
Winnetka, IL 60093-3707
Phone (847) 441-5558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.042372 | IL | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407628800000",
"number": "1386053759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 BROADMEADOW RD",
"city": "WINNETKA",
"state": "IL",
"postal_code": "600933707",
"telephone_number": "847-441-5558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 BROADMEADOW RD",
"city": "WINNETKA",
"state": "IL",
"postal_code": "600933707",
"telephone_number": "847-441-5558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUDENCIO",
"first_name": "RAMIRO",
"middle_name": "FELIX",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-10",
"last_updated": "2014-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IL",
"license": "036.042372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winnetka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.