Healthcare Provider Details

I. General information

NPI: 1083939276
Provider Name (Legal Business Name): RYAN PAUL HURTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2500
US

IV. Provider business mailing address

PO BOX 6002
URBANA IL
61803-6002
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3313
  • Fax: 217-383-4014
Mailing address:
  • Phone: 217-326-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036131975
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: