Provider Demographics
NPI:1962939165
Name:BEAN, RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7411 HOPE DR STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5687
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:260-234-5395
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084461A207R00000X
MI4301112007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300041791Medicaid
INQ00261098OtherRAILROAD PTAN
INP02645932OtherRAILROAD PTAN