Provider Demographics
NPI:1922296664
Name:FILIATREAU, RYAN PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:FILIATREAU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2405 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3329
Practice Address - Country:US
Practice Address - Phone:859-278-9492
Practice Address - Fax:859-469-5461
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
610957525OtherCOMMERCIAL
KY000000541266OtherANTHEM
KY1047618Medicare PIN