Individual
MARK S SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 6TH ST, SUITE 200, TRAVERSE CITY, MI 49684-2369
(231) 935-5800
(231) 935-5822
Mailing address
1200 6TH ST, SUITE 200, TRAVERSE CITY, MI 49684-2369
(231) 935-5800
(231) 935-5822
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301055166
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060B86046
GROUP BLUE SHIELD NUMBER
MI
05
—
2753469
—
MI
Enumeration date
06/12/2006
Last updated
07/09/2012
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