Healthcare Provider Details

I. General information

NPI: 1477968097
Provider Name (Legal Business Name): RYAN LYERLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 FRANCE AVE S STE 4200
EDINA MN
55435
US

IV. Provider business mailing address

2925 CHICAGO AVE MAIL ROUTE 10202, PO BOX 43
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1400
  • Fax:
Mailing address:
  • Phone: 612-262-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1477968097
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number59481
License Number StateFM
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number59481
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: