Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03718 | MI |
N | 222Z00000X | Podiatrist | CPO03718 | MI |
Y | 224P00000X | Prosthetist | CPO03718 | MI |
NPI | 1386131662 |
---|---|
Provider Name | Ryan Sheridan |
First Address | Livonia, MI 48152-1337 |
Second Address | Livonia, MI 48152-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2018 |
Last Update Date | 24/10/2020 |