Healthcare Provider Details

I. General information

NPI: 1205761327
Provider Name (Legal Business Name): RYAN STEWART JERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 31ST ST
DOWNERS GROVE IL
60515-1235
US

IV. Provider business mailing address

1212 BECKMAN LN
BATAVIA IL
60510-3345
US

V. Phone/Fax

Practice location:
  • Phone: 630-971-6080
  • Fax:
Mailing address:
  • Phone: 630-940-8777
  • 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: