MEDICARE: RYON MICHAEL HENNESSY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	036-093298	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200028061	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02222323	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093717480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYON MICHAEL HENNESSY MD

Provider Business Mailing Address
First Line	:	360 W BUTTERFIELD RD
Second Line	:	SUITE 160
City	:	ELMHURST
State	:	IL
Zip	:	60126-5068
Country	:	US
Telephone Number	:	630-782-9600
Fax Number	:	630-782-1643

Provider Business Practice Location Address
First Line	:	360 W BUTTERFIELD RD
Second Line	:	SUITE 160
City	:	ELMHURST
State	:	IL
Zip	:	60126-5068
Country	:	US
Telephone Number	:	630-782-9600
Fax Number	:	630-782-1643

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/10/2009

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Directions to “ RYON MICHAEL HENNESSY MD” Practice Location

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