Justin R Staley, DO
Emergency Medicine in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1164044830
StatusActive
Last updated in NPPESSep 9, 2026
Details
- NPI
- 1164044830
- Entity type
- Individual (NPI-1)
- Name
- Justin R Staley
- Credential
- DO
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 15, 2020
- Certification date
- Sep 9, 2026
- Last updated
- Sep 9, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | 5101026712 | MI | Yes |
| 207P00000X | Emergency Medicine | 02008975A | IN | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
200 Jefferson Ave SeGrand Rapids, MI 49503-4502
Phone 616-685-5000
Mailing address
1415 E Shorewood DrNorton Shores, MI 49441-5288
Phone 317-219-8571
Other practice locations
1316 E 7th St
Auburn, IN 46706-2538
Auburn, IN 46706-2538
Phone 260-925-4600
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