Provider Demographics
NPI:1629020300
Name:RYAN, LAWRENCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF RHEUMATOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-7024
Mailing Address - Fax:414-955-6205
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF RHEUMATOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-7024
Practice Address - Fax:414-955-6205
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI18025207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000140XOtherHUMANA
WI1629020300Medicaid
660000589OtherRAILROAD MEDICARE
WI1629020300Medicaid
WI044873601Medicare PIN