MEDICARE: DR. MINA LEE RYU 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	207R00000X	Internal Medicine Physician	036119958	IL

General Provider Information

NPI Number	:	1669484861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINA LEE RYU M.D.

Provider Business Mailing Address
First Line	:	1000 CENTRAL ST STE 640
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1780
Country	:	US
Telephone Number	:	847-570-1410
Fax Number	:	847-869-0520

Provider Business Practice Location Address
First Line	:	1000 CENTRAL ST STE 640
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1780
Country	:	US
Telephone Number	:	847-570-1410
Fax Number	:	847-869-0520

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	02/10/2021

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