Provider Demographics
NPI:1770631384
Name:MICHAEL J RYAN DPM PA
Entity Type:Organization
Organization Name:MICHAEL J RYAN DPM PA
Other - Org Name:RYAN FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL.
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-548-0222
Mailing Address - Street 1:8310 MEDICAL PLAZA DR STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6703
Mailing Address - Country:US
Mailing Address - Phone:704-548-0222
Mailing Address - Fax:704-548-1157
Practice Address - Street 1:8310 MEDICAL PLAZA DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6703
Practice Address - Country:US
Practice Address - Phone:704-548-0222
Practice Address - Fax:704-548-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC284213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU90556Medicare UPIN
NCT83814Medicare UPIN
NCU94947Medicare UPIN
NC4347540001Medicare NSC