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1982868063

NPI Code Detail

MEDICARE: RYAN SYDNOR MD

MEDICARE: RYAN SYDNOR 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	2085R0202X	Diagnostic Radiology Physician	DR.0060778	CO
2	2085R0204X	Vascular & Interventional Radiology Physician	62229 - 20	WI
3	2085R0204X	Vascular & Interventional Radiology Physician	DR.0060778	CO

General Provider Information

NPI Number	:	1982868063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SYDNOR MD

Provider Business Mailing Address
First Line	:	2036 N PROSPECT AVE
Second Line	:	APT. 2005
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1260
Country	:	US
Telephone Number	:	216-210-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 N 92ND ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-1613
Country	:	US
Telephone Number	:	216-210-5521
Fax Number	:

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	11/14/2019

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Directions to “ RYAN SYDNOR MD” Practice Location

Language	Start Address	Practice Location

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