Healthcare Provider Details

I. General information

NPI: 1760777338
Provider Name (Legal Business Name): RYAN MICHAEL MCCARTHY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 YANKEE DOODLE RD
EAGAN MN
55121-2092
US

IV. Provider business mailing address

1110 YANKEE DOODLE RD
EAGAN MN
55121-2092
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-3970
  • Fax:
Mailing address:
  • Phone: 651-454-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number910
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number910
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number910
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMN910
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: