Provider Demographics
NPI:1386225282
Name:RYCKELEY, CHRISTIAN BUTLER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BUTLER
Last Name:RYCKELEY
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 1:357 NC HWY 41
Mailing Address - Street 2:
Mailing Address - City:TAR HEEL
Mailing Address - State:NC
Mailing Address - Zip Code:28392
Mailing Address - Country:US
Mailing Address - Phone:910-876-3697
Mailing Address - Fax:
Practice Address - Street 1:20900 BISCAYNE BLVD STE 8108TH
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1495
Practice Address - Country:US
Practice Address - Phone:305-692-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program