Doctor Name: | MR. RYAN RIDGWAY SULLIVAN |
NPI Number: | 1063701241 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 2160 S 1st Ave Maguire Center, Suite 1700 Maywood, IL - 601533328 |
Business Phone Number: | 7082166906 |
Business Fax Number: | 7082165858 |
Mailing Address: | 2160 S 1st Ave, Maguire Center, Suite 1700 MAYWOOD |
State: | IL |
Postal Code: | 601533328 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/28/2011 |
NPI Last Update Date: | 03/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |