Healthcare Provider Details

I. General information

NPI: 1730680547
Provider Name (Legal Business Name): RYAN SCHUETZLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD STE 525
SKOKIE IL
60076-1217
US

IV. Provider business mailing address

4711 GOLF RD STE 525
SKOKIE IL
60076-1217
US

V. Phone/Fax

Practice location:
  • Phone: 224-470-8550
  • Fax: 224-470-8553
Mailing address:
  • Phone: 224-470-8550
  • Fax: 224-470-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number211.000313
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number213.000345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: