Healthcare Provider Details

I. General information

NPI: 1568389773
Provider Name (Legal Business Name): RYAN WHITESIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9954 BRIARCLIFF CT
NORTHVILLE MI
48167-8639
US

IV. Provider business mailing address

9954 BRIARCLIFF CT
NORTHVILLE MI
48167-8639
US

V. Phone/Fax

Practice location:
  • Phone: 734-796-3670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: