Provider Demographics
NPI:1356922140
Name:SOPPET-RYAN, SAVANNAH LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:LYNN
Last Name:SOPPET-RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAVANNAH
Other - Middle Name:LYNN
Other - Last Name:SOPPET-RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8456 MEADOWS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7046
Mailing Address - Country:US
Mailing Address - Phone:708-663-9937
Mailing Address - Fax:
Practice Address - Street 1:600 RICHARD GORDON HATCHER BLVD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-6001
Practice Address - Country:US
Practice Address - Phone:708-663-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.175996207P00000X
IN01096872A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine