Individual
TRACIE MEDRANO- SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
4174 56TH ST SW, WYOMING, MI 49418
(616) 458-3677
Mailing address
4288 3 MILE RD NW, WALKER, MI 49534-7596
(616) 458-3677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101021683
MI
208000000X
Pediatrics Physician
Primary
5315069986
MI
Other
Enumeration date
06/15/2015
Last updated
08/13/2019
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