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NPI Code Detail

MEDICARE: DR. JEFFREY RYAN PUA M.D.

MEDICARE: DR. JEFFREY RYAN PUA 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
1207R00000XInternal Medicine Physician036-121475IL
2207RB0002XObesity Medicine (Internal Medicine) Physician036-121475IL

Other Identifiers

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

General Provider Information

NPI Number : 1689831778
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY RYAN PUA M.D.
Provider Business Mailing Address
First Line : PO BOX 713260
Second Line :
City : CHICAGO
State : IL
Zip : 60677-1260
Country : US
Telephone Number : 630-469-9200
Fax Number :
Provider Business Practice Location Address
First Line : 801 N CASS AVE STE 300
Second Line :
City : WESTMONT
State : IL
Zip : 60559-1193
Country : US
Telephone Number : 630-348-3840
Fax Number : 630-364-4770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2008
Last Update Date : 08/12/2024

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