Provider Demographics
NPI:1982608519
Name:RYAN, MICHAEL EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWIN
Last Name:RYAN
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 1:8800 W 75TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2205
Mailing Address - Country:US
Mailing Address - Phone:913-632-9810
Mailing Address - Fax:913-632-9828
Practice Address - Street 1:8800 W 75TH ST
Practice Address - Street 2:STE 100
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2205
Practice Address - Country:US
Practice Address - Phone:913-632-9810
Practice Address - Fax:913-632-9828
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-12-19
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
KS04154012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4793785Medicare ID - Type Unspecified
MO4793785AMedicare ID - Type Unspecified
C51723Medicare UPIN