Individual
AMANDA M RYDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 457-0469
Mailing address
PO BOX 1467, INDIANAPOLIS, IN 46206-1467
(618) 457-5200
(618) 529-0568
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036143926
IL
207P00000X
Emergency Medicine Physician
37787
KY
207P00000X
Emergency Medicine Physician
42040
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200445280
—
IN
05
—
64062599
—
KY
Enumeration date
08/17/2006
Last updated
07/21/2022
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