Healthcare Provider Details

I. General information

NPI: 1497918940
Provider Name (Legal Business Name): RYAN JAMES BUCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FEINBERG 16-738
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

3159 N SEMINARY AVE APT 307
CHICAGO IL
60657-3359
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-5924
  • Fax:
Mailing address:
  • Phone: 773-661-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036125102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: