Healthcare Provider Details

I. General information

NPI: 1730075219
Provider Name (Legal Business Name): MANIK NANGIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHERRY ST 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: 616-685-5050
  • Fax:
Mailing address:
  • Phone: 616-685-6774
  • Fax: 616-685-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4351054915
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: