Basic Information
| Provider Information | |||||||||
| NPI: | 1396968889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERKOW | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1233 YORK AVE APT 9J | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100656342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039174201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 21-700 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950990 | ||||||||
| FaxNumber: | 3126951144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 036126063 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208600000X | 036126063 | IL | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.