Provider Demographics
NPI:1619437068
Name:HOOGMOED, RYAN CORNELIUS
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CORNELIUS
Last Name:HOOGMOED
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 1:1725 W HARRISON ST STE 450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4828
Mailing Address - Country:US
Mailing Address - Phone:312-942-4184
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4828
Practice Address - Country:US
Practice Address - Phone:312-942-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program