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Organization
RYAN S. DIEDERICH, MD PC
Active
Organization
RYAN S. DIEDERICH, MD PC
Active
Other names
MidAmerica Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN S DIEDERICH MD (OWNER)
(618) 288-7855
Entity
Organization
Contact information
Practice address
4955 S STATE ROUTE 159 # 1, GLEN CARBON, IL 62034-1907
(618) 288-7855
(618) 288-7866
Mailing address
4955 S STATE ROUTE 159 # 1, GLEN CARBON, IL 62034-1907
(618) 288-7855
(618) 288-7866
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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