Provider Demographics
NPI:1306163571
Name:RYAN, MARIA CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CHRISTINE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CHRISTINE
Other - Last Name:CARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15450 HIGHWAY 7 STE 125
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3522
Mailing Address - Country:US
Mailing Address - Phone:763-520-7870
Mailing Address - Fax:763-520-7888
Practice Address - Street 1:15450 HIGHWAY 7 STE 125
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3522
Practice Address - Country:US
Practice Address - Phone:763-520-7870
Practice Address - Fax:763-520-7888
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54065207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1306163571Medicaid