Healthcare Provider Details

I. General information

NPI: 1750604617
Provider Name (Legal Business Name): RYAN MICHAEL GREYTAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 04/02/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 E CESAR CHAVEZ BLVD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4855 E CESAR CHAVEZ BLVD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax:
Mailing address:
  • Phone: 559-255-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA126390
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA126390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: