Healthcare Provider Details

I. General information

NPI: 1538295845
Provider Name (Legal Business Name): LARRY MADISON RYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HUSTON DR STE 1
SHEPHERDSVILLE KY
40165-7250
US

IV. Provider business mailing address

PO BOX 766351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-7311
  • Fax: 502-955-9694
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43434
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43434
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: