Healthcare Provider Details

I. General information

NPI: 1386225282
Provider Name (Legal Business Name): CHRISTIAN BUTLER RYCKELEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 BISCAYNE BLVD STE 8108TH
AVENTURA FL
33180-1495
US

IV. Provider business mailing address

357 NC HWY 41
TAR HEEL NC
28392
US

V. Phone/Fax

Practice location:
  • Phone: 305-692-3392
  • Fax:
Mailing address:
  • Phone: 910-876-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: