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NPI Code Detail

MEDICARE: RYAN MIGUEL COLON PA-C

MEDICARE: RYAN MIGUEL COLON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085006413IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1085006413OTHERILSTATE LICENSE
21145764OTHERILNCCPA

General Provider Information

NPI Number : 1134648389
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN MIGUEL COLON PA-C
Provider Business Mailing Address
First Line : 10001 W INNOVATION DR STE 200
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-4851
Country : US
Telephone Number : 888-938-3838
Fax Number : 888-919-1083
Provider Business Practice Location Address
First Line : 925 N MILWAUKEE AVE UNIT 200
Second Line :
City : VERNON HILLS
State : IL
Zip : 60061-1637
Country : US
Telephone Number : 888-938-3838
Fax Number : 888-919-1083
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2017
Last Update Date : 05/20/2024

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