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General NPI Number Information
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NPI Number | 1295295293
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Entity Type | Individual
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Provider Name | RYAN MEEDER MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 1 E ERIE ST STE 355
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City | CHICAGO
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State | IL
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Zip | 60611-2772
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Country | US
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Telephone | 312-573-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 8920 W 121ST ST
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City | PALOS PARK
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State | IL
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Zip | 60464-1131
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Country | US
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Telephone | 708-833-9848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036.169042
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License Number State | IL
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