Healthcare Provider Details

I. General information

NPI: 1053568485
Provider Name (Legal Business Name): RYAN MICHAEL THOMAS H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3843 MOLLER RD
INDIANAPOLIS IN
46254-2930
US

IV. Provider business mailing address

934 CALVARY ST
INDIANAPOLIS IN
46203-1018
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-3376
  • Fax:
Mailing address:
  • Phone: 317-557-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001312A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: