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NPI Code Detail

MEDICARE: ADAM MICHAEL RYAN RBT

MEDICARE: ADAM MICHAEL RYAN RBT
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
1103K00000XBehavior Analyst1-24-77318IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11295223634OTHERILNPI

General Provider Information

NPI Number : 1295223634
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM MICHAEL RYAN RBT
Provider Business Mailing Address
First Line : 6458 CITY WEST PKWY
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3245
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2018
Last Update Date : 12/10/2025

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