Individual
RYAN A PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 975-1845
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
5101014120
MI
207P00000X
Emergency Medicine Physician
5101014120
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
5101014120
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00077095
RAILROAD MEDICARE
—
01
—
RP014120
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/25/2005
Last updated
02/21/2025
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