Healthcare Provider Details

I. General information

NPI: 1659013688
Provider Name (Legal Business Name): GRACE ELIZABETH TSALOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 MACATAWA DR SW STE A
GRANDVILLE MI
49418-3184
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845 100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301511924
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301511924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: