Provider Demographics
NPI:1487834958
Name:VAUGHN, RYAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 E WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4714
Mailing Address - Country:US
Mailing Address - Phone:773-234-5880
Mailing Address - Fax:
Practice Address - Street 1:814 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4714
Practice Address - Country:US
Practice Address - Phone:773-234-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.130646207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.130646OtherIL STATE LICENSE NUMBER
IL604340004Medicare PIN