Healthcare Provider Details

I. General information

NPI: 1538205539
Provider Name (Legal Business Name): VIVEK BALUJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VIVEK BALUJA MD

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE SUITE 3003
GRAND RAPIDS MI
49503-2514
US

IV. Provider business mailing address

9110 COLLEGE POINTE CT # MC845
FORT MYERS FL
33919-3244
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2500
  • Fax: 616-267-2501
Mailing address:
  • Phone: 239-208-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberP20581
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number4301102633
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2017-01338
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-48848
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301102633
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.132402
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14954
License Number StateND
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD191107
License Number StateOR
# 9
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME132291
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMED-PHYS-LIC-76853
License Number StateMT
# 11
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18778
License Number StateNH
# 12
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTM00763
License Number StateTX
# 13
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number26126
License Number StateMS
# 14
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number2017-01338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: