Provider Demographics
NPI:1336557271
Name:JAMES T RYAN D O PLLC
Entity Type:Organization
Organization Name:JAMES T RYAN D O PLLC
Other - Org Name:RYAN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAN, SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-425-4447
Mailing Address - Street 1:300 S RATH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-3003
Mailing Address - Country:US
Mailing Address - Phone:231-425-4447
Mailing Address - Fax:231-425-4401
Practice Address - Street 1:300 S RATH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-3003
Practice Address - Country:US
Practice Address - Phone:231-425-4447
Practice Address - Fax:231-425-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI510106838261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM19520029OtherMEDICARE