RYAN DIEDERICH (NPI# 1942422498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942422498 |
| Entity Type | Individual |
| Full Name | RYAN DIEDERICH |
| Credential | MD |
| Practice Address |
6812 State Route 162 Maryville IL 62062-8553 |
| Mailing Address |
6810 State Route 162 Box 215 Maryville IL 62062-8501 |
| Practice Telephone | 6182887855 |
| Practice Fax Number | 6182887866 |
| Mailing Telephone | 6183916405 |
| Mailing Fax Number | 6182884088 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-01-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
125-050203 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104236108 | Ryan Diederich | Physical Therapy Assistant | 2827 Northgate Blvd, Fort Wayne, IN 46835-2900 | 2014-04-30 |
| Street Address |
6812 STATE ROUTE 162 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-8553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447252978 | Brett R Grebing | Orthopaedic Surgery | 6812 State Route 162, Suite 123, Maryville, IL 62062 | 2005-08-15 |
| 1114454733 | Michael Barajas | Physician Assistant | 6812 State Route 162, Suite 120, Maryville, IL 62062-8553 | 2017-05-12 |
| 1043757867 | Alyssa Ruwe | Nurse Practitioner | 6812 State Route 162, Suite 123, Maryville, IL 62062-8553 | 2017-01-31 |
| 1689092132 | Alyssa Ryanne Goddard Verheyen | Nurse Practitioner | 6812 State Route 162, Suite 202, Maryville, IL 62062-8553 | 2014-04-02 |
| 1922348002 | Laura E. Mckinzie | Nurse Practitioner | 6812 State Route 162, Suite 21, Maryville, IL 62062-8553 | 2013-02-26 |
| 1053656298 | Alan Michael Meredith | Physician Assistant | 6812 State Route 162, Suite 21, Maryville, IL 62062 | 2012-11-28 |
| 1124261219 | Maryville Physicians Services Inc | Orthopaedic Surgery | 6812 State Route 162, Suite 123, Maryville, IL 62062-8553 | 2009-04-20 |
| 1912117912 | Edmundo Alejandro Rodriguez | Internal Medicine | 6812 State Route 162, Suite 204, Maryville, IL 62062 | 2007-05-22 |
| 1922159037 | Kevin Bradley Garner | Internal Medicine | 6812 State Route 162, Suite 204, Maryville, IL 62062-8553 | 2007-01-15 |
| 1700960572 | Rodney L. Greeling | Internal Medicine | 6812 State Route 162, Ste 21, Maryville, IL 62062 | 2006-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467074617 | Dewolfe Aesthetic Services Sc | Surgery | 3357 N. Southport Aveune, Chicago, IL 60657 | 2020-05-11 |
| 1578068524 | Jw Operatory | Surgery | 1811 Saint Johns Ave Ste 100, Highland Park, IL 60035-5607 | 2018-03-29 |
| 1780198796 | Lin Plastic and Reconstructive Surgery Inc | Surgery | 730 W Couch Pl Unit 1409, Chicago, IL 60661-1383 | 2017-11-29 |
| 1750892923 | Alban Ingram Miller Jr. | Surgery | 1708 Foxborough Ct, Champaign, IL 61822-8503 | 2017-10-16 |
| 1972905545 | Jennifer Hein | Surgery | 2631 Williamsburg Ave Ste 102, Geneva, IL 60134-1108 | 2014-09-25 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1043559842 | Msa Alliance, LLC | Surgery | 1 Broadway Plz, Sparta, IL 62286-1800 | 2013-02-14 |
| 1518223791 | Hansel M Debartolo Jr Md Sc | Surgery | 11 Debartolo Dr., Sugar Grove, IL 60554 | 2012-04-02 |
| 1952692717 | Georgios Kokosis | Surgery | 1725 W Harrison St Ste 425, Chicago, IL 60612-3893 | 2011-04-28 |
| 1740596808 | Swedishamerican Hospital | Surgery | 6533 Lexus Dr, Rockford, IL 61108 | 2010-08-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.