Provider Demographics
NPI:1629573662
Name:RILEY, JOHN B (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3100 N WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8122
Mailing Address - Country:US
Mailing Address - Phone:164-336-0036
Mailing Address - Fax:616-920-6533
Practice Address - Street 1:739 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6045
Practice Address - Country:US
Practice Address - Phone:616-994-2770
Practice Address - Fax:616-920-6533
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2023-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101027426207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery