Provider Demographics
NPI:1831690767
Name:CALDWELL, RYAN J (CP/L)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:CP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S376 SUMMIT AVE
Mailing Address - Street 2:COURT E
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3985
Mailing Address - Country:US
Mailing Address - Phone:630-705-4092
Mailing Address - Fax:630-424-0467
Practice Address - Street 1:1701 E WOODFIELD RD STE 555
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5130
Practice Address - Country:US
Practice Address - Phone:847-619-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211000216224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist