Provider Demographics
NPI:1578791729
Name:UNGER, RYAN (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:UNGER
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 1:425 JOLIET ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1768
Mailing Address - Country:US
Mailing Address - Phone:219-488-0165
Mailing Address - Fax:708-562-0129
Practice Address - Street 1:2450 WOLF RD
Practice Address - Street 2:SUITE D
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5643
Practice Address - Country:US
Practice Address - Phone:708-483-7007
Practice Address - Fax:708-562-0129
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132459208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132459Medicaid
IL12523840OtherCAQH
IL036132459Medicaid