Healthcare Provider Details

I. General information

NPI: 1649292376
Provider Name (Legal Business Name): COLLEEN RYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/12/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADISON STATE HOSPITAL 711 GREEN RD.
MADISON IN
47250
US

IV. Provider business mailing address

1385 S 3RD ST
LOUISVILLE KY
40208-2305
US

V. Phone/Fax

Practice location:
  • Phone: 812-265-7336
  • Fax: 812-265-7487
Mailing address:
  • Phone: 502-558-3192
  • Fax: 502-409-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number01035114A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37977
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: