Provider Demographics
NPI:1275708398
Name:HATCHELL, RYAN NEIL (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NEIL
Last Name:HATCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13950 W CAPITOL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:262-781-3065
Mailing Address - Fax:262-781-3835
Practice Address - Street 1:13950 W CAPITOL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:262-781-3065
Practice Address - Fax:262-781-3835
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2016-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI53771208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275708398Medicaid