Healthcare Provider Details

I. General information

NPI: 1831690767
Provider Name (Legal Business Name): RYAN J CALDWELL CP/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E WOODFIELD RD STE 555
SCHAUMBURG IL
60173-5130
US

IV. Provider business mailing address

1S376 SUMMIT AVE COURT E
OAKBROOK TERRACE IL
60181-3985
US

V. Phone/Fax

Practice location:
  • Phone: 847-619-1701
  • Fax:
Mailing address:
  • Phone: 630-705-4092
  • Fax: 630-424-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number211000216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: