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Individual

RYAN K FONTANILLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5270
(616) 455-5460
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301088070
MI
2084P0800X
Psychiatry Physician
8366A
WY

Other

Enumeration date
05/17/2007
Last updated
12/18/2013
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