Basic Information
| Provider Information | |||||||||
| NPI: | 1184815870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COATES | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 N MCCLURG CT | ||||||||
| Address2: | #3104 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108834890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9555 S 52ND AVE | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604533054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086845437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125-049523 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0402X | 036.121161 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No ID Information.