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General NPI Number Information
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NPI Number | 1003705807
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Entity Type | Individual
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Provider Name | MICHAELA THERESE RYAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 905 E COLBY ST STE 120
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City | WHITEHALL
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State | MI
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Zip | 49461-1262
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Country | US
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Telephone | 231-672-8050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932988
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City | CLEVELAND
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State | OH
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Zip | 44193-0029
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Country | US
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Telephone | 800-494-5797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601013044
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License Number State | MI
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