Healthcare Provider Details

I. General information

NPI: 1306163571
Provider Name (Legal Business Name): MARIA CHRISTINE RYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA CHRISTINE CARROW M.D.

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15450 HIGHWAY 7 STE 125
MINNETONKA MN
55345-3522
US

IV. Provider business mailing address

15450 HIGHWAY 7 STE 125
MINNETONKA MN
55345-3522
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-7870
  • Fax: 763-520-7888
Mailing address:
  • Phone: 763-520-7870
  • Fax: 763-520-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number54065
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: