Provider Demographics
NPI:1033346770
Name:FOLKERT, MICHAEL RYAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RYAN
Last Name:FOLKERT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 FOREST PARK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9183
Mailing Address - Country:US
Mailing Address - Phone:214-645-2112
Mailing Address - Fax:214-645-7617
Practice Address - Street 1:5801 FOREST PARK RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9183
Practice Address - Country:US
Practice Address - Phone:214-645-2112
Practice Address - Fax:214-645-7617
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ14022085R0001X, 207R00000X
NY258770207R00000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine