Provider Demographics
NPI:1760508030
Name:RYAN, PATRICIA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HOGBACK RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9752
Mailing Address - Country:US
Mailing Address - Phone:734-677-5900
Mailing Address - Fax:734-677-0476
Practice Address - Street 1:2020 HOGBACK RD
Practice Address - Street 2:SUITE 15
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9752
Practice Address - Country:US
Practice Address - Phone:734-677-5900
Practice Address - Fax:734-677-0476
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010541192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P5308002Medicare PIN
MIA13965Medicare UPIN