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Organization

LAKEWOOD FAMILY MEDICINE PLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIMOTHY VICTOR SMITH MD (PHYSICIAN)
(616) 396-6516
Entity
Organization

Contact information

Practice address
382 N 120TH AVE, HOLLAND, MI 49424-2169
(616) 396-6516
(616) 396-2513
Mailing address
382 N 120TH AVE, HOLLAND, MI 49424-2169
(616) 396-6516
(616) 396-2513

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080G06011
BCBS MI GROUP NUMBER
MI
Enumeration date
10/05/2006
Last updated
11/09/2018
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