Individual
LISA MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
520 MAIN ST, DOWAGIAC, MI 49047-1762
(269) 783-3052
Mailing address
5943 STADIUM DR, KALAMAZOO, MI 49009-3016
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006698
MI
363AM0700X
Medical Physician Assistant
3512
AZ
Other
Enumeration date
10/13/2006
Last updated
07/18/2013
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