Provider Demographics
NPI:1376950881
Name:FELL, RYAN S (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:FELL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2323 N MAYFAIR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1506
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-727-1058
Practice Address - Street 1:2323 N MAYFAIR RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1506
Practice Address - Country:US
Practice Address - Phone:414-384-6700
Practice Address - Fax:414-727-1058
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-08-20
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Provider Licenses
StateLicense IDTaxonomies
WI3368-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376950881Medicaid
WI1376950881Medicaid