Provider Demographics
NPI:1538295845
Name:RYLE, LARRY MADISON (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MADISON
Last Name:RYLE
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 766351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:115 HUSTON DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7250
Practice Address - Country:US
Practice Address - Phone:502-955-7311
Practice Address - Fax:502-955-9694
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY43434208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000681099OtherANTHEM - NICC
KY116658OtherSIHO - NMA
KY50029638OtherPASSPORT & PASSPORT ADVTG
KY9132559OtherAETNA - NCMA
KY000000668794OtherANTHEM - NMA
KY120281OtherSIHO - NICC
KY7100127660Medicaid
KYP00861081OtherRAILROAD MEDICARE - KY
KY000052153UOtherHUMANA - NMA
KY5725912OtherCIGNA - NMA
KYP400019680Medicare PIN