Individual
STANLEY R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
330 E MITCHELL ST, #210, PETOSKEY, MI 49770-2671
(734) 677-7400
(734) 677-7407
Mailing address
PO BOX 1108, ATTN: BARB SIMMONS, ANN ARBOR, MI 48106-1108
(231) 627-5601
(231) 627-1592
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301030812
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B41005
BCBS GROUP PIN
MI
05
—
4372499
—
MI
Enumeration date
04/22/2006
Last updated
01/28/2010
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