Healthcare Provider Details

I. General information

NPI: 1477243517
Provider Name (Legal Business Name): RYAN ABBOTT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W HARRISON ST
CHICAGO IL
60607-3532
US

IV. Provider business mailing address

901 W HARRISON ST
CHICAGO IL
60607-3532
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-4600
  • Fax:
Mailing address:
  • Phone: 312-864-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125.081798
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: