Provider Demographics
NPI:1225662547
Name:RIESSEN, RYAN THOMAS (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:RIESSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 475
Mailing Address - Street 2:
Mailing Address - City:GRAFENWOEHR
Mailing Address - State:BAVARIA
Mailing Address - Zip Code:92655
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 475
Practice Address - Street 2:
Practice Address - City:GRAFENWOEHR
Practice Address - State:BAVARIA
Practice Address - Zip Code:92655
Practice Address - Country:DE
Practice Address - Phone:314-950-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026462207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine