Individual
WAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3210 EAGLE RUN DR NE STE 100, GRAND RAPIDS, MI 49525-7051
(616) 279-3725
Mailing address
PO BOX 1847, MUSKEGON, MI 49443-1847
(231) 672-4900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101011102
MI
2083X0100X
Occupational Medicine Physician
Primary
5101011102
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4615238
—
MI
Enumeration date
07/31/2006
Last updated
11/21/2019
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