Provider Demographics
NPI:1740300482
Name:SEWELL, RYAN KIRK (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KIRK
Last Name:SEWELL
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 1:720 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-6109
Mailing Address - Country:US
Mailing Address - Phone:402-397-0670
Mailing Address - Fax:402-397-0713
Practice Address - Street 1:720 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-6109
Practice Address - Country:US
Practice Address - Phone:402-397-0670
Practice Address - Fax:402-397-0713
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25702207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47056003300Medicaid
NE095345005Medicare PIN