Individual
MICHAEL G RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19485 OLD JETTON RD, SUITE 100, CORNELIUS, NC 28031-6582
(704) 384-1775
(704) 384-1776
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-1775
(704) 384-1776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01023417
IN
207Q00000X
Family Medicine Physician
Primary
200901870
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000067648
ANTHEM BCBS
IN
01
—
080162612
MEDICARE RAILROAD
—
05
—
200307000A
—
IN
01
—
415089P
SIHO
IN
01
—
4255189
AETNA
—
05
—
64022296
—
KY
Enumeration date
07/11/2006
Last updated
04/01/2010
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