Provider Demographics
NPI:1538205539
Name:BALUJA, VIVEK (MD)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:BALUJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VIVEK
Other - Middle Name:
Other - Last Name:BALUJA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9110 COLLEGE POINTE CT # MC845
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3244
Mailing Address - Country:US
Mailing Address - Phone:239-208-2212
Mailing Address - Fax:
Practice Address - Street 1:35 MICHIGAN ST NE
Practice Address - Street 2:SUITE 3003
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2514
Practice Address - Country:US
Practice Address - Phone:616-267-2500
Practice Address - Fax:616-267-2501
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP205812080P0008X
MI43011026332080P0008X, 2084N0400X
NC2017-013382084N0400X
MTMED-PHYS-LIC-768532084N0400X
ORMD1911072084N0400X
OH35.1324022084N0400X
NH187782084N0400X
ND149542084N0400X
MS261262084N0400X
TXTM007632084N0400X
FLME1322912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538205539Medicaid
CO62004271Medicaid
NH3116042Medicaid