Organization · Type 2 NPI
Ryan S. Diederich, MD PC
Plastic and Reconstructive Surgery Physician · Glen Carbon, IL
NPI number
1639817182
Active
Practice location
4955 S State Route 159 # 1
Glen Carbon, IL 62034-1907
Fax (618) 288-7866
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Plastic and Reconstructive Surgery Physician Primary | 2086S0122X | None listed |
Plastic and Reconstructive Surgery Physician: A surgeon who specializes in plastic and reconstructive surgery.
About NPI 1639817182
Ryan S. Diederich, MD PC's National Provider Identifier is 1639817182, issued on May 24, 2022. The primary taxonomy on file is Plastic and Reconstructive Surgery Physician (2086S0122X), and the practice location is in Glen Carbon, IL. The record was last updated on May 24, 2022.