Basic Information
| Provider Information | |||||||||
| NPI: | 1366975666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | EARL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 N SAINT CLAIR ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126955753 | ||||||||
| FaxNumber: | 3126955645 | ||||||||
| Practice Location | |||||||||
| Address1: | 676 N SAINT CLAIR ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126955753 | ||||||||
| FaxNumber: | 3126955645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TRN24706 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0202X | ME137215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | D36.159804 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 036159804 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.