Provider Demographics
NPI:1497999551
Name:RYAN, HEIDI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:KUHLENSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 GRAND MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6098
Mailing Address - Country:US
Mailing Address - Phone:702-448-5578
Mailing Address - Fax:702-703-2375
Practice Address - Street 1:4275 BURNHAM AVE STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5400
Practice Address - Country:US
Practice Address - Phone:702-448-5578
Practice Address - Fax:702-703-2375
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery