Provider Demographics
NPI:1629324538
Name:HOLMBECK, RYAN JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:HOLMBECK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9697 SAINT CATHERINES DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2118
Mailing Address - Country:US
Mailing Address - Phone:626-563-3382
Mailing Address - Fax:262-656-3368
Practice Address - Street 1:9697 SAINT CATHERINES DR STE 300
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53158-2118
Practice Address - Country:US
Practice Address - Phone:262-656-3338
Practice Address - Fax:262-656-3368
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005554213ES0103X
WI1037213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery