Provider Demographics
NPI:1376915439
Name:KORDIAK, RYAN MICHAEL (ADC-T)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MICHAEL
Last Name:KORDIAK
Suffix:
Gender:M
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 YORK AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-926-2526
Mailing Address - Fax:952-926-6791
Practice Address - Street 1:6550 YORK AVE SOUTH
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-926-2526
Practice Address - Fax:952-926-6791
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator