Provider Demographics
NPI:1528356086
Name:RYAN, MICHAEL (CERTIFIED PEDORTHIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4381
Mailing Address - Country:US
Mailing Address - Phone:608-238-3807
Mailing Address - Fax:
Practice Address - Street 1:6220 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3481
Practice Address - Country:US
Practice Address - Phone:608-890-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist