Individual
DR. KEVIN M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
829 N CENTER AVE, SUITE 210, GAYLORD, MI 49735-1595
(989) 731-7860
(989) 731-7833
Mailing address
829 N CENTER AVE, SUITE 298, GAYLORD, MI 49735-1595
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101016410
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OF96004
MEDICARE GROUP NUMBER
—
Enumeration date
05/08/2007
Last updated
12/30/2020
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