Provider Demographics
NPI:1639150683
Name:RYAN, PATRICIA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 E CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7505
Mailing Address - Country:US
Mailing Address - Phone:517-883-6546
Mailing Address - Fax:517-432-9460
Practice Address - Street 1:463 E CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7505
Practice Address - Country:US
Practice Address - Phone:517-883-6546
Practice Address - Fax:517-432-9460
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0851900115OtherBLUE CROSS BLUE SHIELD
MI0101936OtherPHYSICIANS HEALTH PLAN
MI080D410020OtherBLUE CARE NETWORK
MI1639150683Medicaid
MI5180305OtherAETNA
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherCOMMUNITY BLUE
MI1014874OtherHEALTH ADVANTAGE NETWORK
MI080D410020OtherBLUE CHOICE
MIG21314OtherHEALTH NET FED SERVICES
MI1014874OtherMCLAREN HEALTH PLAN
MI4748682Medicaid
MI0101936OtherPHYSICIANS HEALTH PLAN
MI1014874OtherMCLAREN HEALTH PLAN
MI4748682Medicaid