Basic Information
| Provider Information | |||||||||
| NPI: | 1932561271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANDIFORD | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 W DETROIT ST | ||||||||
| Address2: | |||||||||
| City: | NEW BUFFALO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491171636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697207419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1234 NAPIER AVE | ||||||||
| Address2: | LAKELAND HEALTH-GME | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490852112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699824941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 5101024560 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.