Individual
RYAN DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4955 S STATE ROUTE 159 STE 1, GLEN CARBON, IL 62034-1907
(618) 288-7855
(618) 288-7866
Mailing address
4955 S STATE ROUTE 159 STE 1, GLEN CARBON, IL 62034-1907
(618) 288-7855
(618) 288-7866
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
125-050203
IL
Other
Enumeration date
05/03/2007
Last updated
08/21/2024
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