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: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 2100
GRAND RAPIDS MI
49503-2526
US

IV. Provider business mailing address

3890 CLEARVIEW ST NE
GRAND RAPIDS MI
49546-1386
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3777
  • Fax:
Mailing address:
  • Phone: 812-249-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: