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General NPI Number Information
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NPI Number | 1760466726
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Entity Type | Individual
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Provider Name | RYAN GARNER MIHATA MD
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 1 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-3403
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Country | US
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Telephone | 859-757-2927
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Fax | 859-341-0203
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Provider Business Mailing Address
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Address Line | 4700 LAS VEGAS BLVD N
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City | NELLIS AFB
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State | NV
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Zip | 89191-6600
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Country | US
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Telephone | 702-653-2273
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01066636A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 35.120207
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | C2689
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License Number State | KY
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