Healthcare Provider Details

I. General information

NPI: 1235989484
Provider Name (Legal Business Name): RYAN ALEXANDER GALLO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SOUTH WOOD STREET SUITE 100, MC 675
CHICAGO IL
60612
US

IV. Provider business mailing address

820 SOUTH WOOD STREET SUITE 100, MC 675
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2933
  • Fax:
Mailing address:
  • Phone: 312-996-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: