1710123351 NPI number — DR. MARK LEO RYAN MD, MSPH

Table of content: DR. MARK LEO RYAN MD, MSPH (NPI 1710123351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710123351 NPI number — DR. MARK LEO RYAN MD, MSPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
MARK
Provider Middle Name:
LEO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MSPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYAN
Provider Other First Name:
MARK
Provider Other Middle Name:
LEO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MSPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710123351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 GILLHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64108-4619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-234-3000
Provider Business Mailing Address Fax Number:
816-302-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 GILLHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-234-3000
Provider Business Practice Location Address Fax Number:
816-302-9939
Provider Enumeration Date:
01/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X , with the licence number:  2025005442 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)