Provider Demographics
NPI:1366693772
Name:LAKIN, RYAN OERTELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:OERTELL
Last Name:LAKIN
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:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43552-0934
Mailing Address - Country:US
Mailing Address - Phone:312-720-9313
Mailing Address - Fax:
Practice Address - Street 1:241 N SUPERIOR ST
Practice Address - Street 2:SUITE 301
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1234
Practice Address - Country:US
Practice Address - Phone:419-214-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097929208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice