Individual provider Active NPI

Nilda Disaris Perez Perez, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Grand Rapids, MI
National Provider Identifier
1053983833
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
4351048821 Issued in MI
Practice address
35 Michigan St NE Ste 3003
Grand Rapids, MI 49503-2528
Phone
(616) 267-2500
Fax
(616) 267-2501
NPI assigned
Jul 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 4351048821 MI Primary

Addresses

Primary practice location

35 Michigan St NE Ste 3003
Grand Rapids, MI 49503-2528

Mailing address

35 Michigan St NE Ste 3003
Grand Rapids, MI 49503-2528
Phone (616) 267-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210721002442 MI Order and Referring Only - Pediatric MedicinePractitioner - NeurologyPractitioner - Pediatric Medicine 0840693354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1053983833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 MICHIGAN ST NE STE 3003",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032528",
            "telephone_number": "616-267-2500",
            "fax_number": "616-267-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MICHIGAN ST NE STE 3003",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032528",
            "telephone_number": "616-267-2500",
            "fax_number": "616-267-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ PEREZ",
        "first_name": "NILDA",
        "middle_name": "DISARIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": "4351048821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.