Individual
TIMOTHY RIDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
251 E HURON ST, CHICAGO, IL 60611-2908
(312) 926-6895
Mailing address
251 E HURON ST, CHICAGO, IL 60611-2908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005782
IL
Other
Enumeration date
04/13/2016
Last updated
07/23/2016
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