Healthcare Provider Details

I. General information

NPI: 1912081589
Provider Name (Legal Business Name): DHANASHREE MAHESH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 MEDICAL PARK DR SE
GRAND RAPIDS MI
49546-3607
US

IV. Provider business mailing address

6600 MAHESH DR SE
GRAND RAPIDS MI
49546-7100
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-9610
  • Fax: 616-954-3110
Mailing address:
  • Phone: 616-971-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301047740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: