Basic Information
| Provider Information | |||||||||
| NPI: | 1790153831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVERTHORN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2874 TALL OAKS CT | ||||||||
| Address2: | APT 11 | ||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483264171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482516984 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6071 W OUTER DR | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139663300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2015 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 5303001592 | MI | N | Pharmacy Service Providers | Pharmacy Technician | 246RP1900X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy | 163WC0200X | 4704352012 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10089389 | 01 | MI | PTCB | OTHER | 5303001592 | 01 | MI | MI LARA BOARD OF PHARMACY LICENSE | OTHER | 4704352012 | 01 | MI | MICHIGAN BOARD OF NURSING | OTHER |