Healthcare Provider Details

I. General information

NPI: 1144042425
Provider Name (Legal Business Name): RYAN ELY SAXON H.I.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SKOKIE VALLEY RD
HIGHLAND PARK IL
60035-4403
US

IV. Provider business mailing address

5413 OAK PARK RD UNIT 2
OAKWOOD HILLS IL
60013-1009
US

V. Phone/Fax

Practice location:
  • Phone: 847-681-7000
  • Fax:
Mailing address:
  • Phone: 847-462-8795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: