Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
RYAN DIEDERICH, MD
ActiveRYAN DIEDERICH, MD is a Plastic and Reconstructive Surgery healthcare provider located in GLEN CARBON, Illinois. NPI 1942422498 is currently active in the NPPES registry. Verify at CMS.
Plastic and Reconstructive Surgery · GLEN CARBON, IL
Registration Details
- NPI Number
- 1942422498
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 3, 2007 (19.297876121378 yrs)
- Last Updated
- Aug 21, 2024
- License
-
125-050203 (IL)
Practice Information
- Address
-
4955 S STATE ROUTE 159 STE 1GLEN CARBON, IL, 620341907Browse IL providers · Browse ZIP 62034
- Phone
- 6182887855
- Fax
- 6182887866
- Primary Specialty
-
Plastic and Reconstructive Surgery
2086S0122X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.