Provider Demographics
NPI:1861229700
Name:ACKS, RYAN J (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:ACKS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:804 SERVICE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-6100
Mailing Address - Fax:517-884-6233
Practice Address - Street 1:4660 S HAGADORN RD STE 420
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5353
Practice Address - Country:US
Practice Address - Phone:517-884-6100
Practice Address - Fax:517-884-6233
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
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Provider Licenses
StateLicense IDTaxonomies
MI5601012663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant