Provider Demographics
NPI:1730202482
Name:RYAN FOOT CLINIC, PC
Entity type:Organization
Organization Name:RYAN FOOT CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-758-5770
Mailing Address - Street 1:25511 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1834
Mailing Address - Country:US
Mailing Address - Phone:586-758-5770
Mailing Address - Fax:586-758-6134
Practice Address - Street 1:25511 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1834
Practice Address - Country:US
Practice Address - Phone:586-758-5770
Practice Address - Fax:586-758-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M85050Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
MI1243610001Medicare NSC