Provider Demographics
NPI:1639606239
Name:MARKS, RYAN ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANTHONY
Last Name:MARKS
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 1:125 DWYER ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1002
Mailing Address - Country:US
Mailing Address - Phone:989-386-9721
Mailing Address - Fax:989-386-9749
Practice Address - Street 1:125 DWYER ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1002
Practice Address - Country:US
Practice Address - Phone:989-386-9721
Practice Address - Fax:989-386-9749
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5951000902390200000X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5951000902OtherEDUCATION LIMITED LICENSE