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General NPI Number Information
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NPI Number | 1215085832
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Entity Type | Organization
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Legal Business Name | MICHAEL J RYAN DPM PA
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 492 COPPERFIELD BLVD NE
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City | CONCORD
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State | NC
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Zip | 28025-2404
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Country | US
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Telephone | 704-548-0222
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Fax | 704-548-1157
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Provider Business Mailing Address
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Address Line | 492 COPPERFIELD BLVD NE
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City | CONCORD
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State | NC
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Zip | 28025-2404
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Country | US
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Telephone | 704-788-9797
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Fax | 704-788-6830
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J RYAN
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Credential | DPM
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Telephone | 704-788-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 463
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License Number State | NC
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