Healthcare Provider Details

I. General information

NPI: 1588956635
Provider Name (Legal Business Name): CHADRICK RYAN EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST SUITE 300
PEORIA IL
61606-1907
US

IV. Provider business mailing address

1001 MAIN ST SUITE 300
PEORIA IL
61606-1907
US

V. Phone/Fax

Practice location:
  • Phone: 309-495-0201
  • Fax: 309-676-6545
Mailing address:
  • Phone: 309-495-0201
  • Fax: 309-676-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036138899
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number36138899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: