Provider Demographics
NPI:1881057321
Name:CANTWELL, RYAN (DPM)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CANTWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 N WICKHAM RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2200
Mailing Address - Country:US
Mailing Address - Phone:321-266-7236
Mailing Address - Fax:321-454-9877
Practice Address - Street 1:2717 N WICKHAM RD STE 4
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2200
Practice Address - Country:US
Practice Address - Phone:321-253-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4041213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery