Healthcare Provider Details

I. General information

NPI: 1053368290
Provider Name (Legal Business Name): RYAN D. TORRIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 S A ST
ELWOOD IN
46036-1942
US

IV. Provider business mailing address

1331 S A ST
ELWOOD IN
46036-1942
US

V. Phone/Fax

Practice location:
  • Phone: 765-552-4600
  • Fax: 765-552-4680
Mailing address:
  • Phone: 765-552-4600
  • Fax: 765-552-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01059455
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: