Individual
KENNETH E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30795 23 MILE RD STE 201, CHESTERFIELD, MI 48047-5721
(586) 421-1600
(586) 421-2002
Mailing address
2689 SOLUTION CENTER, CHICAGO, IL 60677-2308
(586) 329-1880
(586) 231-0055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301059550
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E04360
BLUE CROSS BLUE SHIELDS OF MICHIGAN
MI
Enumeration date
07/05/2005
Last updated
03/08/2021
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