Healthcare Provider Details

I. General information

NPI: 1982451787
Provider Name (Legal Business Name): RUCHA DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/31/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

200 JEFFERSON SE MEDICAL EDUCATION-SUITE 305
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6922
  • Fax: 616-685-5192
Mailing address:
  • Phone: 616-685-6741
  • Fax: 616-685-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351052876
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: