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NPI 1063758530ActiveOrganization· Specialist· Tinley Park, IL

Specialist in Tinley Park, Illinois, registered in NPPES in January 2013. The authorized official on file is Ryan King, Manager.

Overview

NPI1063758530
StatusActive
Entity typeOrganization
NPI issuedJan 2, 2013
Last updated in NPPESJan 2, 2013

Specialties and licenses

TaxonomyCodeLicenseState
Specialist Primary174400000X——

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 10, 2026No match—
New York OMIG · Nov 10, 2026No match—
Ohio Medicaid · Nov 10, 2026No match—
Pennsylvania Medicheck · Nov 10, 2026No match—
Washington HCA · Nov 10, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Not in the public enrollment file of Oct 1, 2026

Medicare sources and data years

Other Specialist providers in Tinley Park

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