MEDICARE: RYLIE O'MEARA

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	2086S0129X	Vascular Surgery Physician	125.085475	IL

General Provider Information

NPI Number	:	1225896624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLIE O'MEARA

Provider Business Mailing Address
First Line	:	1432 N MAPLEWOOD AVE APT 304
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1878
Country	:	US
Telephone Number	:	402-570-6287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 N MAPLEWOOD AVE APT 304
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1878
Country	:	US
Telephone Number	:	402-570-6287
Fax Number	:

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

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	06/23/2025

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Directions to “ RYLIE O'MEARA ” Practice Location

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