Individual
DR. JEFFREY RYAN PUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 N CASS AVE STE 300, WESTMONT, IL 60559-1193
(630) 348-3840
(630) 364-4770
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-121475
IL
207RB0002X
Obesity Medicine (Internal Medicine) Physician
Primary
036-121475
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121475
—
IL
Enumeration date
05/17/2008
Last updated
08/12/2024
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