Provider Demographics
NPI:1699768820
Name:STEEN, STACYANN (MD)
Entity type:Individual
Prefix:
First Name:STACYANN
Middle Name:
Last Name:STEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACYANN
Other - Middle Name:
Other - Last Name:STEEN-VANOENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 221
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-685-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4092969Medicaid
MIM80080003Medicare PIN
MI4092969Medicaid
MIP32930281Medicare PIN
MIM02830186Medicare PIN