Provider Demographics
NPI:1447715131
Name:RYAN KLANSECK, DO
Entity type:Organization
Organization Name:RYAN KLANSECK, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEMBERSHIP & PMS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSKEGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-213-0253
Mailing Address - Street 1:16986 ROBBINS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2795
Mailing Address - Country:US
Mailing Address - Phone:616-229-3295
Mailing Address - Fax:
Practice Address - Street 1:16986 ROBBINS RD STE 140
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2795
Practice Address - Country:US
Practice Address - Phone:616-229-3295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty