Healthcare Provider Details

I. General information

NPI: 1134322308
Provider Name (Legal Business Name): MAULI A VERMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 E CENTRE AVE
PORTAGE MI
49002-4420
US

IV. Provider business mailing address

2176 E CENTRE AVE STE 302
PORTAGE MI
49002-4420
US

V. Phone/Fax

Practice location:
  • Phone: 269-459-1284
  • Fax: 269-459-1297
Mailing address:
  • Phone: 269-459-1284
  • Fax: 269-459-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301083534
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301083534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: