Healthcare Provider Details

I. General information

NPI: 1356437263
Provider Name (Legal Business Name): SARAH A SMOES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HOBART ST
CADILLAC MI
49601-2379
US

IV. Provider business mailing address

PO BOX 1024
CADILLAC MI
49601-6024
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-8814
  • Fax: 231-775-8854
Mailing address:
  • Phone: 231-775-6076
  • Fax: 231-775-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: