Individual
RYAN F MAKUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 CHESTNUT HILL RD, STAFFORD SPRINGS, CT 06076-4005
(860) 749-2201
Mailing address
3334 TOWN BROOKE, MIDDLETOWN, CT 06457-6611
(860) 632-8191
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002203
CT
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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