Individual
RYAN MARK TISHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12047 BLACKTHORNE RIDGE DR, MOKENA, IL 60448-8112
(815) 483-6276
Mailing address
12047 BLACKTHORNE RIDGE DR, MOKENA, IL 60448-8112
(815) 483-6276
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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