Provider Demographics
NPI:1972549186
Name:RYAN, MICHAEL JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:RYAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8310 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6701
Mailing Address - Country:US
Mailing Address - Phone:704-548-0222
Mailing Address - Fax:704-548-1157
Practice Address - Street 1:8310 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6701
Practice Address - Country:US
Practice Address - Phone:704-548-0222
Practice Address - Fax:704-548-1157
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC284213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890807FMedicaid
NC2431826AMedicare PIN
NCT83814Medicare UPIN