Healthcare Provider Details

I. General information

NPI: 1578146338
Provider Name (Legal Business Name): KALI MARIE SANFORD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE STE 306
GRAND RAPIDS MI
49503-4607
US

IV. Provider business mailing address

PO BOX 776974
CHICAGO IL
60677-6974
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8750
  • Fax:
Mailing address:
  • Phone: 616-685-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101028687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: