Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125066448 | IL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 036.145406 | IL |
NPI | 1174902472 |
---|---|
Provider Name | Valerie Genevieve Rygiel |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Oak Lawn, IL 60453-3072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 22/12/2021 |