Healthcare Provider Details

I. General information

NPI: 1922083997
Provider Name (Legal Business Name): RYAN MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21647 RYAN RD
WARREN MI
48091-2795
US

IV. Provider business mailing address

21647 RYAN RD
WARREN MI
48091-2795
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-4200
  • Fax: 586-757-8332
Mailing address:
  • Phone: 586-757-4200
  • Fax: 586-757-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. KENNETH MEYERS
Title or Position: PHYSICIAN
Credential: DO
Phone: 586-757-4200