Provider Demographics
NPI:1700863511
Name:RYAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 PHILLIPS LN STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2551
Mailing Address - Country:US
Mailing Address - Phone:805-543-4407
Mailing Address - Fax:805-543-4587
Practice Address - Street 1:1428 PHILLIPS LN STE 203
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2551
Practice Address - Country:US
Practice Address - Phone:805-543-4407
Practice Address - Fax:805-543-4587
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86911207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700863511Medicaid
VAPAROtherMULTIPLAN
VA-029OtherTRICARE/CHAMPUS
VAPAROtherVA PREMIER HEALTH
VAPAROtherVA HEALTH NETWORK
VA7221858OtherAETNA
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL
VA2174181OtherUHC/MAMSI
CAWA86911AMedicaid
NC5908329Medicaid
VA6125139OtherCIGNA
NC08329OtherNC BC/BS
VA10025471OtherSENTARA/OPTIMA
VA342182OtherANTHEM
CA7221858OtherAETNA PIN
VAPAROtherCORVEL/CORECARE
CAWA86911AMedicaid
VAPAROtherVA HEALTH NETWORK
CA7221858OtherAETNA PIN