Provider Demographics
NPI:1578638680
Name:RYBA, DENNIS R (CPO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:RYBA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39830 GRAND RIVER AVE
Mailing Address - Street 2:SUITE B1D
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2140
Mailing Address - Country:US
Mailing Address - Phone:248-477-1443
Mailing Address - Fax:248-477-1509
Practice Address - Street 1:39830 GRAND RIVER AVE
Practice Address - Street 2:SUITE B1D
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2140
Practice Address - Country:US
Practice Address - Phone:248-477-1443
Practice Address - Fax:248-477-1509
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4404770Medicaid
MI0603380001Medicare ID - Type Unspecified