Provider Demographics
NPI:1437457405
Name:HUTCHINSON, RYAN THOMAS
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S CLARK ST
Mailing Address - Street 2:UNIT 815
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1782
Mailing Address - Country:US
Mailing Address - Phone:317-979-0891
Mailing Address - Fax:
Practice Address - Street 1:850 S CLARK ST
Practice Address - Street 2:UNIT 815
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1782
Practice Address - Country:US
Practice Address - Phone:317-979-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004886A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207P00000XMedicaid