Individual
RYAN KEVIN FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1580 BEAM AVE, MAPLEWOOD, MN 55109
(651) 779-7978
(651) 779-7656
Mailing address
2550 UNIVERSITY AVE W STE 110N, SAINT PAUL, MN 55114-2001
(651) 602-5309
(651) 222-6786
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012018706
MO
2085R0001X
Radiation Oncology Physician
107113
MN
2085R0001X
Radiation Oncology Physician
Primary
56878
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P01249784
RAILROAD MEDICARE
MN
Enumeration date
06/18/2012
Last updated
06/25/2018
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