MEDICARE: COLIN MCPHILLIPS RYAN L.P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	178.005814	IL

General Provider Information

NPI Number	:	1093952814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN MCPHILLIPS RYAN L.P.C

Provider Business Mailing Address
First Line	:	2213 W ROSCOE ST # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6209
Country	:	US
Telephone Number	:	773-329-6968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 W ROSCOE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6209
Country	:	US
Telephone Number	:	773-329-6968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/21/2009

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