Provider Demographics
NPI:1144269432
Name:DEVESHWAR, RAJEEV (MD)
Entity type:Individual
Prefix:
First Name:RAJEEV
Middle Name:
Last Name:DEVESHWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:25 MICHIGAN ST NE STE 6100
Practice Address - Street 2:SPECTRUM HEALTH MEDICAL GROUP NEUROVASCULAR/STROKE OFFI
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2561
Practice Address - Country:US
Practice Address - Phone:616-267-7900
Practice Address - Fax:616-267-7901
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361007892084N0400X, 2085R0202X, 2085R0204X
MI43010533802084V0102X, 2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4748OtherMEDICARE RAILROAD (GROUP)
206147OtherMEDICARE PTAN (GROUP)
P00904920OtherMEDICARE RAILROAD (INDIVIDUAL)
206147039OtherMEDICARE PTAN (INDIVIDUAL)
P00904920OtherMEDICARE RAILROAD (INDIVIDUAL)