Healthcare Provider Details

I. General information

NPI: 1871815753
Provider Name (Legal Business Name): STEVEN JAMES SMITH DAT, MPA, AT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S STATE ST
ANN ARBOR MI
48109-2203
US

IV. Provider business mailing address

1200 S STATE ST
ANN ARBOR MI
48109-2203
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-0719
  • Fax: 734-763-8056
Mailing address:
  • Phone: 734-936-0719
  • Fax: 734-763-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: