Provider Demographics
NPI:1063438844
Name:STANFORD, BARBARA E (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:STANFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 228
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:300 LAFAYETTE SE
Practice Address - Street 2:STE 4200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-685-6922
Practice Address - Fax:616-685-5105
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4203843Medicaid
MI4877250Medicaid
MI4877760Medicaid
MI4394084Medicaid
MI4289098Medicaid
MI4810804Medicaid
MIN49800002Medicare ID - Type Unspecified
MI4394084Medicaid
MI4289098Medicaid
MIP32930162Medicare PIN