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Individual
PATRICK KELLY SMITH
Active
Individual
PATRICK KELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5601004116
MI
363A00000X
Physician Assistant
5601004116
MI
363A00000X
Physician Assistant
Primary
PA60940050
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142901
GREAT LAKES HEALTH PLAN
—
01
—
201
COMMUNITY CHOICE OF MI
MI
01
—
3381330
MOLINA HEALTH CARE
MI
01
—
381908328
TRICARE
—
Enumeration date
10/06/2005
Last updated
05/05/2021
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