Provider Demographics
NPI:1407472087
Name:KEMPA STADT, MOLLY (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:KEMPA STADT
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 1:721 3 MILE RD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8224
Mailing Address - Country:US
Mailing Address - Phone:616-647-3770
Mailing Address - Fax:616-647-3788
Practice Address - Street 1:721 3 MILE RD NW STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8224
Practice Address - Country:US
Practice Address - Phone:616-647-3770
Practice Address - Fax:616-647-3788
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine