Provider Demographics
NPI:1881089910
Name:GREENE, RYAN MICHAEL (DO, MS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:GREENE
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8720 W SUNSET BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2206
Mailing Address - Country:US
Mailing Address - Phone:630-569-1287
Mailing Address - Fax:310-878-2540
Practice Address - Street 1:8720 W SUNSET BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-2206
Practice Address - Country:US
Practice Address - Phone:630-569-1287
Practice Address - Fax:310-878-2540
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A156022083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine