Healthcare Provider Details

I. General information

NPI: 1497945901
Provider Name (Legal Business Name): RYAN M KRLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 HOUMA BLVD STE 302
METAIRIE LA
70006-4310
US

IV. Provider business mailing address

1542 TULANE AVE LSU DEPT OF UROLOGY, RM 547
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1600
  • Fax: 504-412-1626
Mailing address:
  • Phone: 504-568-2207
  • Fax: 504-568-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD.201386
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.094859
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberMD.201386
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: