Healthcare Provider Details

I. General information

NPI: 1972549186
Provider Name (Legal Business Name): MICHAEL JOSEPH RYAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 MEDICAL PLAZA DR
CHARLOTTE NC
28262-6701
US

IV. Provider business mailing address

8310 MEDICAL PLAZA DR
CHARLOTTE NC
28262-6701
US

V. Phone/Fax

Practice location:
  • Phone: 704-548-0222
  • Fax: 704-548-1157
Mailing address:
  • Phone: 704-548-0222
  • Fax: 704-548-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: