Provider Demographics
NPI:1972792117
Name:HELMICK, RYAN A (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:HELMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-9183
Mailing Address - Fax:901-516-8993
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:SUITE 184
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-9183
Practice Address - Fax:901-516-8993
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN53310208600000X, 204F00000X
OH57.013910208600000X
TXP2667208600000X
MN106876208600000X
MN106883208600000X
MN56911208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014206Medicaid
TN103I028824Medicare PIN
TXTXB159106Medicare PIN
TX304497601Medicaid
MN020003430Medicare PIN
TX8DL776OtherBCBS