Healthcare Provider Details

I. General information

NPI: 1205745957
Provider Name (Legal Business Name): FLYNN A SMITH LLC, MACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W GRAND BLVD STE 370
DETROIT MI
48202-3008
US

IV. Provider business mailing address

4252 LESLIE ST
DETROIT MI
48238-3245
US

V. Phone/Fax

Practice location:
  • Phone: 313-932-5527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451025266
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: