Healthcare Provider Details

I. General information

NPI: 1548176563
Provider Name (Legal Business Name): KEVANNA SMITH PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 N CANTON CENTER RD STE 293
CANTON MI
48187-2684
US

IV. Provider business mailing address

5840 N CANTON CENTER RD STE 293
CANTON MI
48187-2684
US

V. Phone/Fax

Practice location:
  • Phone: 734-404-4174
  • Fax: 734-823-1206
Mailing address:
  • Phone: 734-404-4174
  • Fax: 734-823-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number190609140025
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: