Individual
RYAN JOSEPH BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(414) 672-1353
(414) 672-4265
Mailing address
PO BOX 778789, CHICAGO, IL 60677-8789
(414) 672-1353
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301107467
MI
207R00000X
Internal Medicine Physician
Primary
72160-20
WI
207R00000X
Internal Medicine Physician
MD467682
PA
208000000X
Pediatrics Physician
4301107467
MI
208000000X
Pediatrics Physician
72160-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0230085
BCBS
MI
05
—
100103241
—
WI
01
—
114008
SID # 114008
CA
05
—
1750655643
—
MI
Enumeration date
02/24/2012
Last updated
06/27/2023
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