Provider Demographics
NPI:1851688139
Name:GLEESING, RYAN JOHN (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:GLEESING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43900 GARFIELD RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1128
Mailing Address - Country:US
Mailing Address - Phone:586-286-0050
Mailing Address - Fax:586-286-0880
Practice Address - Street 1:43900 GARFIELD RD
Practice Address - Street 2:SUITE 222
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1128
Practice Address - Country:US
Practice Address - Phone:586-286-0050
Practice Address - Fax:586-286-0880
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019373207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3971113Medicare PIN