Healthcare Provider Details

I. General information

NPI: 1548689730
Provider Name (Legal Business Name): RYAN GERRITSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ARCH ST STE 2A
AKRON OH
44304-1424
US

IV. Provider business mailing address

55 ARCH ST STE 2A
AKRON OH
44304-1424
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-6917
  • Fax: 330-535-1539
Mailing address:
  • Phone: 330-375-6917
  • Fax: 330-535-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number35.138042
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: