Healthcare Provider Details

I. General information

NPI: 1255856027
Provider Name (Legal Business Name): RONALD ALVARADO DYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC2030
CHICAGO IL
60637
US

IV. Provider business mailing address

180 HARVESTER DR
BURR RIDGE IL
60527-7594
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6222
  • Fax: 773-834-7250
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125071832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: