Provider Demographics
NPI:1710986765
Name:CMEJREK, RYAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:CMEJREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:99 E 86TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6381
Mailing Address - Country:US
Mailing Address - Phone:219-738-2617
Mailing Address - Fax:219-769-5830
Practice Address - Street 1:99 E 86TH AVE
Practice Address - Street 2:STE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6381
Practice Address - Country:US
Practice Address - Phone:219-738-2617
Practice Address - Fax:219-769-5830
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2009-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01060618A207Y00000X, 207YP0228X, 207YS0123X, 207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN226670AMedicare ID - Type Unspecified
INI32525Medicare UPIN