Individual
RYAN NIEHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
995 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5588
(812) 353-3060
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-3087
(812) 353-5859
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02004042A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201074530
—
IN
Enumeration date
05/20/2008
Last updated
12/18/2020
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