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
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
09/28/2021
Last updated
01/15/2026
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