Healthcare Provider Details

I. General information

NPI: 1487006474
Provider Name (Legal Business Name): RYAN HINMAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-8797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35120819
License Number StateOH

VIII. Authorized Official

Name: RYAN HINMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 937-384-8797