Healthcare Provider Details

I. General information

NPI: 1255673489
Provider Name (Legal Business Name): RYAN JEFFREY PHILE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE CLEVELAND CLINIC - DESK J1-5
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE CLEVELAND CLINIC - DESK L10
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-8526
  • Fax: 216-445-6164
Mailing address:
  • Phone: 216-319-0694
  • Fax: 216-445-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003752
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003752RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: