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General NPI Number Information
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NPI Number | 1790526234
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Entity Type | Individual
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Provider Name | KATHLEEN N RYAN DO
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Gender | Female
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 28050 GRAND RIVER AVE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5919
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Country | US
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Telephone | 947-521-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4987 HILLCREST AVE
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City | OKEMOS
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State | MI
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Zip | 48864-1036
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Country | US
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Telephone | 269-615-1262
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 5151016819
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License Number State | MI
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