Healthcare Provider Details

I. General information

NPI: 1841278843
Provider Name (Legal Business Name): DAVID L RIPLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 E ERIE ST
CHICAGO IL
60611-3167
US

IV. Provider business mailing address

355 E ERIE ST
CHICAGO IL
60611-3167
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-1000
  • Fax: 312-238-8405
Mailing address:
  • Phone: 312-238-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number036-130612
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-130612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: