Basic Information
| Provider Information | |||||||||
| NPI: | 1578880068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERBERT | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2007 95TH ST | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605648459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305273200 | ||||||||
| FaxNumber: | 6305273201 | ||||||||
| Practice Location | |||||||||
| Address1: | 2007 95TH ST | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605648459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305273200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.133472 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 54132 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.