Provider Demographics
NPI:1588956635
Name:EVANS, CHADRICK RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHADRICK
Middle Name:RYAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1907
Mailing Address - Country:US
Mailing Address - Phone:309-495-0201
Mailing Address - Fax:309-676-6545
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1907
Practice Address - Country:US
Practice Address - Phone:309-495-0201
Practice Address - Fax:309-676-6545
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL361388992086S0102X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138899-1Medicaid