Healthcare Provider Details

I. General information

NPI: 1508753948
Provider Name (Legal Business Name): MARCUS SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E EISENHOWER PKWY
ANN ARBOR MI
48108-3231
US

IV. Provider business mailing address

3200 E EISENHOWER PKWY
ANN ARBOR MI
48108-3231
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-0070
  • Fax:
Mailing address:
  • Phone: 310-770-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: