Individual
DR. STEPHEN TIMOTHY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(800) 653-6568
(313) 876-1305
Mailing address
300 WARREN CT, BIRMINGHAM, MI 48009-3302
(248) 495-8984
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036-124708
IL
207RC0000X
Cardiovascular Disease Physician
Primary
4301044365
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060H264410
BLUE CROSS-BLUE CROSS
—
05
—
143671610
—
MI
01
—
SS044365
CHAMPUS-CHAMPUS
—
Enumeration date
12/01/2006
Last updated
04/04/2023
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