Individual
MARK SMALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3950 HOLLYWOOD RD, SUITE 270, SAINT JOSEPH, MI 49085-9159
(269) 982-7840
(269) 982-7843
Mailing address
3950 HOLLYWOOD RD, SUITE 270, SAINT JOSEPH, MI 49085-9159
(269) 982-7840
(269) 982-7843
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MS007105
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A110280
BCBS
MI
01
—
110203217
RAIL ROAD MEDICARE
MI
Enumeration date
03/21/2006
Last updated
05/07/2019
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