Provider Demographics
NPI:1710043641
Name:DANIEL J RYAN MD PC
Entity Type:Organization
Organization Name:DANIEL J RYAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-1214
Mailing Address - Street 1:1113 VILLA LINDE CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3410
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:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-733-1214
Practice Address - Fax:810-733-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
07308OtherM CARE
0988882OtherGENESEE HEALTH PLAN
7650396OtherAETNA
1004688OtherMCLAREN HEALTH PLAN
180044733OtherRR MEDICARE
MI4218962Medicaid
DR068574OtherBLUE CHOICE THRU BCN
MI0988882OtherHEALTH PLUS
1004688OtherMCLAREN HEALTH ADVANTAGE
MI1802505282OtherBCBS
1802505282OtherBLUE CROSS NETWORK
1867250OtherFIRST HEALTH
C7308OtherKIDS CARE OF MI
=========OtherPPOM
1004688OtherMCLAREN HEALTH ADVANTAGE
MI4557340001Medicare NSC