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General NPI Number Information
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NPI Number | 1710156369
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Entity Type | Organization
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Legal Business Name | MARK RYERSON
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 125 E CENTRAL RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-2649
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Country | US
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Telephone | 847-255-0330
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Fax | 847-255-1785
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Provider Business Mailing Address
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Address Line | 125 E CENTRAL RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-2649
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Country | US
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Telephone | 847-255-0330
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Fax | 847-255-1785
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK A RYERSON
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Credential | D.P.M.
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Telephone | 847-255-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016003397
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 016003397
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016003397
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License Number State | IL
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