Individual
RYAN STEPHEN FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
804 SERVICE RD STE D100, EAST LANSING, MI 48824-7015
(517) 353-5053
(517) 432-4394
Mailing address
804 SERVICE RD, STE D100, EAST LANSING, MI 48824-7015
(517) 353-5053
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301095664
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932286945
—
MI
Enumeration date
11/01/2006
Last updated
12/10/2018
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