1144533381 NPI number — DR. RYAN RICHARD KONWINSKI M.D.

Table of content: DR. RYAN RICHARD KONWINSKI M.D. (NPI 1144533381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144533381 NPI number — DR. RYAN RICHARD KONWINSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONWINSKI
Provider First Name:
RYAN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144533381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3264 N EVERGREEN DR NE
Provider Second Line Business Mailing Address:
DIAGNOSTIC RADIOLOGY RESIDENCY
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49525-9746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-363-7339
Provider Business Mailing Address Fax Number:
616-361-5828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MICHIGAN ST NE # MC-046
Provider Second Line Business Practice Location Address:
DIAGNOSTIC RADIOLOGY RESIDENCY
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-391-9087
Provider Business Practice Location Address Fax Number:
616-391-9124
Provider Enumeration Date:
07/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4301097114 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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