Healthcare Provider Details

I. General information

NPI: 1639664931
Provider Name (Legal Business Name): CLAYTON JOSEPH LUYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

221 MICHIGAN ST NE STE 402
GRAND RAPIDS MI
49503-2538
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8953
  • Fax: 616-840-9665
Mailing address:
  • Phone: 616-391-1929
  • Fax: 616-391-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301115773
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: