Healthcare Provider Details

I. General information

NPI: 1700264769
Provider Name (Legal Business Name): RYAN LEAHY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

1901 S CALUMET AVE UNIT 1112
CHICAGO IL
60616-6008
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-4000
  • Fax:
Mailing address:
  • Phone: 630-240-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036146180
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberOS17335
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036146180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: