Ryan Diederich, MD - Surgery in Glen Carbon, IL

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Ryan Diederich, MD is a Surgery - Plastic And Reconstructive Surgery physician based in Glen Carbon, Illinois. Ryan Diederich is licensed to practice in Illinois (license number 125-050203) and his current practice location is 4955 S State Route 159 Ste 1, Glen Carbon, Illinois. He can be reached at his office (for appointments etc.) via phone at (618) 288-7855.

NPI number for Ryan Diederich is 1942422498 and his current mailing address is 4955 S State Route 159 Ste 1, Glen Carbon, Illinois. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1942422498.

Contact Information

Ryan Diederich, MD
4955 S State Route 159 Ste 1,
Glen Carbon, IL 62034-1907
(618) 288-7855
(618) 288-7866

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Physician's Profile

Full NameRyan Diederich
GenderMale
SpecialitySurgery - Plastic And Reconstructive Surgery
Location4955 S State Route 159 Ste 1, Glen Carbon, Illinois
Accepts Medicare AssignmentsDoes not participate in Medicare Program. He may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1942422498
  • Provider Enumeration Date: 05/03/2007
  • Last Update Date: 08/21/2024

Medical Identifiers

Medical identifiers for Ryan Diederich such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1942422498NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2086S0122XSurgery - Plastic And Reconstructive Surgery 125-050203 (Illinois)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ryan Diederich is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Ryan Diederich, MD
4955 S State Route 159 Ste 1,
Glen Carbon, IL 62034-1907

Ph: (618) 288-7855		Ryan Diederich, MD
4955 S State Route 159 Ste 1,
Glen Carbon, IL 62034-1907

Ph: (618) 288-7855

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Surgery Doctors in Glen Carbon, IL


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