Individual
DR. MARK SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
Mailing address
7064 FOREST WAY, BRIGHTON, MI 48116-4700
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301068364
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4301068364
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104129951
—
MI
05
—
104274943
—
MI
05
—
104288626
—
MI
01
—
MS068364
BC/BS OF MICHIGAN
MI
Enumeration date
07/03/2006
Last updated
06/07/2010
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