Provider Demographics
NPI:1902882913
Name:DEHAAN, RYAN D (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:DEHAAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 SOUTH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2116
Mailing Address - Country:US
Mailing Address - Phone:402-465-1900
Mailing Address - Fax:402-465-1940
Practice Address - Street 1:5440 SOUTH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2116
Practice Address - Country:US
Practice Address - Phone:402-465-1900
Practice Address - Fax:402-465-1940
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45701207ZP0105X
NE24093207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110164100Medicaid
MNP00041300Medicare ID - Type UnspecifiedRAILROAD