Healthcare Provider Details

I. General information

NPI: 1851972707
Provider Name (Legal Business Name): NEELAY DIVYESH PUROHIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E PARIS AVE SE STE 100
GRAND RAPIDS MI
49546-8368
US

IV. Provider business mailing address

3890 CLEARVIEW ST NE
GRAND RAPIDS MI
49546-1386
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-7200
  • Fax: 616-459-8312
Mailing address:
  • Phone: 812-249-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301510722
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: