Provider Demographics
NPI:1104888916
Name:RYAN, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5901 N LIDGERWOOD ST
Mailing Address - Street 2:STE 118
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1122
Mailing Address - Country:US
Mailing Address - Phone:509-483-2828
Mailing Address - Fax:509-484-7882
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:STE 118
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1122
Practice Address - Country:US
Practice Address - Phone:509-483-2828
Practice Address - Fax:509-484-7882
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00019784207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAL & IOtherLABOR AND INDUSTRIES
WA1021450Medicaid
WA000301383Medicare ID - Type Unspecified
WAA07378Medicare UPIN