Healthcare Provider Details

I. General information

NPI: 1184516536
Provider Name (Legal Business Name): RAJNISH MISHRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE STE 3003
GRAND RAPIDS MI
49503-2528
US

IV. Provider business mailing address

35 MICHIGAN ST NE STE 3003
GRAND RAPIDS MI
49503-2528
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2300
  • Fax: 616-267-2202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4351055122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: