Basic Information
| Provider Information | |||||||||
| NPI: | 1538295845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYLE | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | MADISON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 766351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 HUSTON DR | ||||||||
| Address2: | |||||||||
| City: | SHEPHERDSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401657250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029557311 | ||||||||
| FaxNumber: | 5029559694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 43434 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 43434 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000681099 | 01 | KY | ANTHEM - NICC | OTHER | 116658 | 01 | KY | SIHO - NMA | OTHER | 50029638 | 01 | KY | PASSPORT & PASSPORT ADVTG | OTHER | 9132559 | 01 | KY | AETNA - NCMA | OTHER | 000000668794 | 01 | KY | ANTHEM - NMA | OTHER | 120281 | 01 | KY | SIHO - NICC | OTHER | 7100127660 | 05 | KY | MEDICAID | P00861081 | 01 | KY | RAILROAD MEDICARE - KY | OTHER | 000052153U | 01 | KY | HUMANA - NMA | OTHER | 5725912 | 01 | KY | CIGNA - NMA | OTHER |