Basic Information
| Provider Information | |||||||||
| NPI: | 1497945901 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KRLIN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 TULANE AVE | ||||||||
| Address2: | LSU DEPT OF UROLOGY, RM 547 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045682207 | ||||||||
| FaxNumber: | 5045683990 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 HOUMA BLVD STE 302 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700064310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121600 | ||||||||
| FaxNumber: | 5044121626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2007 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD.201386 | LA | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 35.094859 | OH | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 3080311 | 05 | OH | MEDICAID | 1077488 | 05 | LA | MEDICAID |