1497750749 NPI number — DR. PAUL D. RYAN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497750749 NPI number — DR. PAUL D. RYAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
PAUL
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497750749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 S FRONTAGE RD
Provider Second Line Business Mailing Address:
SUITE 325
Provider Business Mailing Address City Name:
WOODRIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60517-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-789-3422
Provider Business Mailing Address Fax Number:
630-789-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 SALT CREEK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINSDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60521-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-789-3422
Provider Business Practice Location Address Fax Number:
630-789-9093
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  036084757 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 036-084757 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F400224429 . This is a "MEDICARE - LOCALITY 16" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1912218850 . This is a "NPI GROUP PRACTICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: F400224432 . This is a "MEDICARE - LOCALITY 15" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036084757 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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