Healthcare Provider Details

I. General information

NPI: 1679199178
Provider Name (Legal Business Name): STEPHANY ZAHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 E BELTLINE AVE NE STE 201
GRAND RAPIDS MI
49525-4548
US

IV. Provider business mailing address

200 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4502
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8620
  • Fax:
Mailing address:
  • Phone: 616-685-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351046406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: