MEDICARE: LEONARD P RYBAK M.D.

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	207Y00000X	Otolaryngology Physician	036061928	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194710913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD P RYBAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 19649
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9649
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-7781

Provider Business Practice Location Address
First Line	:	747 N RUTLEDGE ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-6700
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-7781

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/04/2016

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