Provider Demographics
NPI:1821044892
Name:ZANTOW, RYAN T (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:ZANTOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:920-686-5732
Mailing Address - Fax:920-686-5726
Practice Address - Street 1:3509 DEWEY ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5813
Practice Address - Country:US
Practice Address - Phone:920-686-5732
Practice Address - Fax:920-686-5726
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI44776-020208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34827700Medicaid
I50360Medicare UPIN