Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016003397 | IL |
Y | 222Z00000X | Podiatrist | 016003397 | IL |
N | 2081S0010X | Sports Medicine | 016003397 | IL |
N | 213ES0000X | Sports Medicine | 016003397 | IL |
N | 213ES0131X | Foot Surgery | 016003397 | IL |
NPI | 1356395875 |
---|---|
Provider Name | Mark Ryerson |
First Address | Arlington Hts, IL 60005-2649 |
Second Address | Arlington Hts, IL 60005-2649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 18/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37972 | (02) | IL |