Provider Demographics
NPI:1063701241
Name:SULLIVAN, RYAN RIDGWAY (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RIDGWAY
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1331 W 75TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-646-7000
Mailing Address - Fax:630-548-1563
Practice Address - Street 1:1331 W 75TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9311
Practice Address - Country:US
Practice Address - Phone:630-527-3000
Practice Address - Fax:630-548-1563
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.140279207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery