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NPI Code Detail

MEDICARE: MR. RYAN J. HERTWECK PA-C

MEDICARE: MR. RYAN J. HERTWECK 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 AssistantMA055090PA

General Provider Information

NPI Number : 1366723850
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN J. HERTWECK PA-C
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 180 FORT COUCH RD STE 200
Second Line :
City : PITTSBURGH
State : PA
Zip : 15241-1046
Country : US
Telephone Number : 412-595-0430
Fax Number : 412-595-0425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2011
Last Update Date : 10/27/2022

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Directions to “ MR. RYAN J. HERTWECK PA-C” Practice Location

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