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General NPI Number Information
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NPI Number | 1750655643
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Entity Type | Individual
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Provider Name | RYAN JOSEPH BAXTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 2906 S 20TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53215-3732
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Country | US
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Telephone | 414-672-1353
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Fax | 414-672-4265
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Provider Business Mailing Address
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Address Line | PO BOX 778789
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City | CHICAGO
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State | IL
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Zip | 60677-8789
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Country | US
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Telephone | 414-672-1353
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD467682
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301107467
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 72160-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301107467
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 72160-20
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License Number State | WI
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