Healthcare Provider Details

I. General information

NPI: 1215189519
Provider Name (Legal Business Name): ROBERT J. RYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12726 HAMILTON CROSSING BLVD
CARMEL IN
46032-5422
US

IV. Provider business mailing address

12726 HAMILTON CROSSING BLVD
CARMEL IN
46032-5422
US

V. Phone/Fax

Practice location:
  • Phone: 317-249-2242
  • Fax: 317-249-2248
Mailing address:
  • Phone: 317-249-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: