Konstantin Volod Elisevich, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

060725 Issued in MI

Practice address

25 Michigan St NE
Suite 6100
Grand Rapids, MI 49503-2515

Phone

(616) 267-7900

Fax

(616) 267-7901

NPI assigned

Dec 1, 2006

Last updated

Dec 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1841368651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE",
            "address_2": "SUITE 6100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032515",
            "telephone_number": "616-267-7900",
            "fax_number": "616-267-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELISEVICH",
        "first_name": "KONSTANTIN",
        "middle_name": "VOLOD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "060725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eiman Elhouderi, MD
• Elias Dental Lab
• Richard J Elias III, DDS
• Steven Elicegui, MD
• Katelyn Frances Eling, SLP
• Elite Health, PLC
• Elite Spine and Musculoskeletal Center PLLC
• Elite Sports and Family Chiropractic, PLC
• Elizabeth Boshoven LLC
• Elizabeth Droppers PLLC

• Neurological Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Neurological Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.