Healthcare Provider Details

I. General information

NPI: 1184328742
Provider Name (Legal Business Name): RYAN YADAV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 FLOSSIE DR
GREENDALE IN
47025-8424
US

IV. Provider business mailing address

900 S LIMESTONE CTW 304
LEXINGTON KY
40536-7429
US

V. Phone/Fax

Practice location:
  • Phone: 877-670-7264
  • Fax: 812-539-1824
Mailing address:
  • Phone: 859-323-2834
  • Fax: 859-257-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01099267A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: