Provider Demographics
NPI:1124039482
Name:RYAN, ALEXANDRA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:ANNE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:421 N OAK PARK AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2122
Mailing Address - Country:US
Mailing Address - Phone:773-880-8108
Mailing Address - Fax:773-281-4237
Practice Address - Street 1:2300 N CHILDRENS PLZ # 16
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-8108
Practice Address - Fax:773-281-4237
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics