Provider Demographics
NPI:1144533381
Name:KONWINSKI, RYAN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARD
Last Name:KONWINSKI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3264 N EVERGREEN DR NE
Mailing Address - Street 2:DIAGNOSTIC RADIOLOGY RESIDENCY
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-363-7339
Mailing Address - Fax:616-361-5828
Practice Address - Street 1:100 MICHIGAN ST NE # MC-046
Practice Address - Street 2:DIAGNOSTIC RADIOLOGY RESIDENCY
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-9087
Practice Address - Fax:616-391-9124
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2016-06-13
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Provider Licenses
StateLicense IDTaxonomies
MI43010971142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology