Healthcare Provider Details

I. General information

NPI: 1154685022
Provider Name (Legal Business Name): RYAN WESLEY SCHMUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD STE 3200
COLUMBUS OH
43212-3167
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-4263
  • Fax: 614-366-0131
Mailing address:
  • Phone: 614-366-0131
  • Fax: 614-366-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number35.137104
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number125061621
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: