Healthcare Provider Details

I. General information

NPI: 1689599698
Provider Name (Legal Business Name): SARA BETH STAFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

440 W KALAMAZOO AVE
KALAMAZOO MI
49007-3347
US

IV. Provider business mailing address

9604 M 89 LOT 44
RICHLAND MI
49083-9657
US

V. Phone/Fax

Practice location:
  • Phone: 269-553-6000
  • Fax:
Mailing address:
  • Phone: 269-312-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: