Healthcare Provider Details

I. General information

NPI: 1134304512
Provider Name (Legal Business Name): JAN RYSZKOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 COMMENTRY WAY
LITTLE ROCK AR
72223-4598
US

IV. Provider business mailing address

316 COMMENTRY WAY
LITTLE ROCK AR
72223-4598
US

V. Phone/Fax

Practice location:
  • Phone: 501-352-7043
  • Fax:
Mailing address:
  • Phone: 501-352-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number4301091356
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number4301091356
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number4301091356
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberE-5892
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number4301091356
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301091356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: