Healthcare Provider Details

I. General information

NPI: 1780277038
Provider Name (Legal Business Name): SYNERGY NEUROPSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
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
PORTAGE MI
49002-4420
US

V. Phone/Fax

Practice location:
  • Phone: 269-459-1273
  • 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 Number
License Number State

VIII. Authorized Official

Name: MAULI VERMA
Title or Position: OWNER
Credential: M.D.
Phone: 269-459-1273