Provider Demographics
NPI:1114953817
Name:MODLINSKI, RYAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:MODLINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5119
Practice Address - Street 1:4123 DUTCHMANS LN
Practice Address - Street 2:SUITE 401
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-394-6341
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYTP313207QS0010X
TXM8188207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine