Individual
JOHN WILLIAM STANIFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4062 W ROYAL DR, TRAVERSE CITY, MI 49684-8965
(231) 935-0338
(231) 935-0569
Mailing address
1105 SIXTH ST, C/O PAYER ENROLLMENT, TRAVERSE, MI 49684
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2015-01272
NC
207RN0300X
Nephrology Physician
165219
NC
207RN0300X
Nephrology Physician
Primary
4301116578
MI
Other
Enumeration date
04/05/2010
Last updated
12/08/2022
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