Healthcare Provider Details

I. General information

NPI: 1770631384
Provider Name (Legal Business Name): MICHAEL J RYAN DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 MEDICAL PLAZA DR STE E
CHARLOTTE NC
28262-6703
US

IV. Provider business mailing address

8310 MEDICAL PLAZA DR STE E
CHARLOTTE NC
28262-6703
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number284
License Number StateNC

VIII. Authorized Official

Name: MICHAEL. J RYAN
Title or Position: OWNER
Credential: DPM
Phone: 704-548-0222