MEDICARE: RYAN KYLE ALDRICH MD

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	207Q00000X	Family Medicine Physician	24496	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OK400647	OTHER		RAILROAD RETIREMENT TRUST (RR MEDICARE)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760555130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN KYLE ALDRICH MD

Provider Business Mailing Address
First Line	:	3204 MEDICAL PARK DR
Second Line	:
City	:	SHAWNEE
State	:	OK
Zip	:	74804-5014
Country	:	US
Telephone Number	:	405-878-6800
Fax Number	:	405-878-6831

Provider Business Practice Location Address
First Line	:	3204 MEDICAL PARK DR
Second Line	:
City	:	SHAWNEE
State	:	OK
Zip	:	74804-5014
Country	:	US
Telephone Number	:	405-878-6800
Fax Number	:	405-878-6831

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/25/2010

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