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1710207444

NPI Code Detail

MEDICARE: LISA ANN RYAN MD

MEDICARE: LISA 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	207R00000X	Internal Medicine Physician	036.150408	IL
2	207R00000X	Internal Medicine Physician	4301096278	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	:	1710207444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN RYAN MD

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	773-776-4471
Fax Number	:	773-564-3510

Provider Business Practice Location Address
First Line	:	3348 W 87TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3767
Country	:	US
Telephone Number	:	773-776-4471
Fax Number	:

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

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	09/16/2025

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Directions to “ LISA ANN RYAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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