Provider Demographics
NPI:1497750749
Name:RYAN, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:RYAN
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 1:900 S FRONTAGE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4903
Mailing Address - Country:US
Mailing Address - Phone:630-789-3422
Mailing Address - Fax:630-789-9093
Practice Address - Street 1:11 SALT CREEK LN
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2990
Practice Address - Country:US
Practice Address - Phone:630-789-3422
Practice Address - Fax:630-789-9093
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084757207RC0000X
IL036-084757207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400224429OtherMEDICARE - LOCALITY 16
IL1912218850OtherNPI GROUP PRACTICE
ILF400224432OtherMEDICARE - LOCALITY 15
IL036084757Medicaid