Individual
RYAN DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
Mailing address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010868
IL
363A00000X
Physician Assistant
10004693A
IN
Other
Enumeration date
08/29/2023
Last updated
01/03/2025
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