Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125-049523 | IL |
Y | 2084N0402X | Child Neurologist | 036.121161 | IL |
NPI | 1184815870 |
---|---|
Provider Name | Ryan Coates |
First Address | Chicago, IL 60611-5420 |
Second Address | Chicago, IL 60611-5420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 13/11/2012 |