Healthcare Provider Details

I. General information

NPI: 1124039482
Provider Name (Legal Business Name): ALEXANDRA ANNE RYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA ANNE DICKSON M.D.

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ # 16
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

421 N OAK PARK AVE APT 2
OAK PARK IL
60302-2122
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-8108
  • Fax: 773-281-4237
Mailing address:
  • Phone: 773-880-8108
  • Fax: 773-281-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: