Provider Demographics
NPI:1558736736
Name:MCEWAN, RICK
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:MCEWAN
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 1:2435 N SHEFFIELD AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2277
Mailing Address - Country:US
Mailing Address - Phone:773-809-1531
Mailing Address - Fax:
Practice Address - Street 1:230 E OHIO STREET
Practice Address - Street 2:STE 410 #2191
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5288
Practice Address - Country:US
Practice Address - Phone:773-809-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000077363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily