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NPI Code Detail

MEDICARE: RYANN NICOLE MACIEJEWSKI MD

MEDICARE: RYANN NICOLE MACIEJEWSKI 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1861333460
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYANN NICOLE MACIEJEWSKI MD
Provider Business Mailing Address
First Line : 4232 BROADWAY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3068
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9200 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-805-7400
Fax Number : 414-805-7300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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