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Organization
LAFAYETTE MEDICAL SPECIALISTS PLLC
Active
Organization
LAFAYETTE MEDICAL SPECIALISTS PLLC
Active
Other names
Sanford Medical Specialists PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
ALEC WILLIAM GEORGE GREEN (EXECUTIVE VICE PRESIDENT)
(616) 446-6413
Entity
Organization
Contact information
Practice address
15146 16TH AVE, MARNE, MI 49435-9605
(616) 288-6970
Mailing address
15146 16TH AVE, MARNE, MI 49435-9605
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
NULL
133V00000X
Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
NULL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
09/28/2021
Last updated
01/15/2026
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