Healthcare Provider Details

I. General information

NPI: 1346742285
Provider Name (Legal Business Name): MICHAEL GREGORY SMOOT OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-7070
  • Fax: 734-936-7016
Mailing address:
  • Phone: 734-936-7070
  • Fax: 734-936-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number520100841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: