Provider Demographics
NPI:1760992481
Name:MICHELS, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MICHELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3344
Mailing Address - Country:US
Mailing Address - Phone:224-422-8999
Mailing Address - Fax:
Practice Address - Street 1:410 MOHAVE ST
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3344
Practice Address - Country:US
Practice Address - Phone:224-422-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program