Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036.140279 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036.140279 | IL |
NPI | 1063701241 |
---|---|
Provider Name | Dr. Ryan Ridgway Sullivan |
First Address | Naperville, IL 60540-9311 |
Second Address | Naperville, IL 60540-9311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 28/01/2021 |