Provider Demographics
NPI:1548204779
Name:SCHMIDGALL, RYAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DANIEL
Last Name:SCHMIDGALL
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 1:50 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2372
Mailing Address - Country:US
Mailing Address - Phone:309-444-8447
Mailing Address - Fax:309-444-2003
Practice Address - Street 1:50 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2372
Practice Address - Country:US
Practice Address - Phone:309-444-8447
Practice Address - Fax:309-444-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115269Medicaid
IL036115269Medicaid