Individual
RYAN MATTHEW OUILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
23550 PARK ST, STE 100, DEARBORN, MI 48124-2592
(313) 730-0500
(313) 730-0606
Mailing address
23550 PARK ST, STE 100, DEARBORN, MI 48124-2592
(313) 730-0500
(313) 730-0606
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
4301111844
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301111844
MICHIGAN BUREAU OF PROFESSIONAL LICENSING
MI
Enumeration date
06/12/2012
Last updated
02/18/2019
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