Individual
RYAN LEE BASDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
347 S GLADSTONE AVE, AURORA, IL 60506-4877
(618) 973-0615
Mailing address
413 E HARRISON ST, MORTON, IL 61550-1608
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
2083S0010X
IL
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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