Provider Demographics
NPI:1285978072
Name:RYAN, NICHOLAS AARON (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AARON
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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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:502-272-5116
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:SUITE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4713
Practice Address - Country:US
Practice Address - Phone:502-897-0697
Practice Address - Fax:502-897-0658
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039753207V00000X
KYTP440207V00000X
KY48328207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100363060Medicaid
KY204955OtherSIHO
KY50094065OtherPASSPORT
KY00000938709OtherANTHEM
IN201339030Medicaid
K137110Medicare PIN