Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036064828 | IL |
NPI | 1760448674 |
---|---|
Provider Name | Richard J Ready |
First Address | Westmont, IL 60559-1381 |
Second Address | Westmont, IL 60559-1381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036064828 | (05) | IL |
D16241 | (02) | IL |