MEDICARE: DR. RYON WISKA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	5951001133	MI

General Provider Information

NPI Number	:	1649621004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYON WISKA DPM

Provider Business Mailing Address
First Line	:	5777 W MAPLE RD STE 170
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4448
Country	:	US
Telephone Number	:	248-847-3288
Fax Number	:	248-847-3275

Provider Business Practice Location Address
First Line	:	5777 W MAPLE RD STE 170
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4448
Country	:	US
Telephone Number	:	248-847-3288
Fax Number	:	248-847-3275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	04/29/2026

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