MEDICARE: DR. RYAN DANIEL SCHMIDGALL M.D.

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	207Q00000X	Family Medicine Physician	036115269	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548204779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN DANIEL SCHMIDGALL M.D.

Provider Business Mailing Address
First Line	:	50 VALLEY FORGE RD
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-2372
Country	:	US
Telephone Number	:	309-444-8447
Fax Number	:	309-444-2003

Provider Business Practice Location Address
First Line	:	50 VALLEY FORGE RD
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-2372
Country	:	US
Telephone Number	:	309-444-8447
Fax Number	:	309-444-2003

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	02/17/2010

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