Provider Demographics
NPI:1134173701
Name:RISTOW, RYAN R (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:R
Last Name:RISTOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 ALUM CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7357
Mailing Address - Country:US
Mailing Address - Phone:614-323-8337
Mailing Address - Fax:
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-794-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083945207Q00000X
KY39733207Q00000X
NMMD2005-0521207Q00000X
NC2005-01654207Q00000X
ORMD26041207Q00000X
NV12288207Q00000X
WAMD00047593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2495401Medicaid
I11502Medicare UPIN
KY0398237Medicare PIN