MEDICARE: DR. HEIDI ANN RYAN MD

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
1	208600000X	Surgery Physician	15363	NV

General Provider Information

NPI Number	:	1497999551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI ANN RYAN MD

Provider Business Mailing Address
First Line	:	11 GRAND MASTERS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-6098
Country	:	US
Telephone Number	:	702-448-5578
Fax Number	:	702-703-2375

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE STE 230
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5400
Country	:	US
Telephone Number	:	702-448-5578
Fax Number	:	702-703-2375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	07/21/2022

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