Provider Demographics
NPI:1164909172
Name:RYAN, MADELINE LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LOUISE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:RHINESMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29943 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:317-706-3415
Mailing Address - Fax:317-706-3417
Practice Address - Street 1:11595 N MERIDIAN ST STE 402
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6947
Practice Address - Country:US
Practice Address - Phone:317-706-7246
Practice Address - Fax:317-706-3417
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002488A363AS0400X
IN100024888A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical