Healthcare Provider Details

I. General information

NPI: 1699768820
Provider Name (Legal Business Name): STACYANN STEEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACYANN STEEN-VANOENE MD

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE STE 100
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 STATE ST SE STE 221
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301058226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: