Basic Information
| Provider Information | |||||||||
| NPI: | 1922450246 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BURMEISTER | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 LAFAYETTE AVE SE | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166856919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 LAFAYETTE AVE SE | ||||||||
| Address2: | SUITE 3000 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166856919 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2016 | ||||||||
| LastUpdateDate: | 07/11/2016 | ||||||||
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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 | 207R00000X | 4301110744 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 5315077927 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.