Provider Demographics
NPI:1629040068
Name:RYAN, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1113 VILLA LINDE CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-733-1214
Mailing Address - Fax:810-733-3011
Practice Address - Street 1:1113 VILLA LINDE CT
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-733-1214
Practice Address - Fax:810-733-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068574207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1867250OtherFIRST HEALTH
0988882OtherGENESEE HEALTH PLAN
MIC7308OtherM-CARE
1004688OtherMCLAREN HEALTH ADVANTAGE
MI1802505282OtherBCBS
1004688OtherMCLAREN HEALTH PLAN
7650196OtherAETNA
C7308OtherKIDS CARE OF MI
DR068574OtherBLUE CHOICE THRU BCN
MI4218962Medicaid
MI0988882OtherHEALTH PLUS
MI1802505282OtherBLUE CARE NETWORK
H19526OtherHEALTH ALLIANCE PLAN
0988882OtherGENESEE HEALTH PLAN