# LAFAYETTE MEDICAL SPECIALISTS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sanford Medical Specialists PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598437642
- **Authorized official:** ALEC WILLIAM GEORGE GREEN (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (616) 446-6413

## Contact information

- **Practice address:** 15146 16TH AVE, MARNE, MI 49435-9605
- **Practice address phone:** (616) 288-6970
- **Mailing address:** 15146 16TH AVE, MARNE, MI 49435-9605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 09/28/2021
- **Last updated:** 01/15/2026