MEDICARE: DR. RALPH G. RYAN M.D.

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	207RC0000X	Cardiovascular Disease Physician	4301043406	MI
2	207RC0000X	Cardiovascular Disease Physician	036054943	IL
3	207RI0011X	Interventional Cardiology Physician	4301043406	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548254972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH G. RYAN M.D.

Provider Business Mailing Address
First Line	:	2700 BAKER ST FL 3
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-2157
Country	:	US
Telephone Number	:	231-737-1335
Fax Number	:	231-737-0534

Provider Business Practice Location Address
First Line	:	14 LAKE ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2606
Country	:	US
Telephone Number	:	708-383-0113
Fax Number	:	708-383-9911

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	01/02/2020

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