Healthcare Provider Details

I. General information

NPI: 1811510191
Provider Name (Legal Business Name): JOSEPH EDWARD PEROSKY MD, MSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE STE 206
GRAND RAPIDS MI
49503-4607
US

IV. Provider business mailing address

330 BARCLAY AVE NE STE 304
GRAND RAPIDS MI
49503-2527
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8750
  • Fax:
Mailing address:
  • Phone: 616-391-2160
  • Fax: 616-391-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301512621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: