Healthcare Provider Details

I. General information

NPI: 1104934603
Provider Name (Legal Business Name): RICK JOEL SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 E GRAND RIVER AVE SUITE100
EAST LANSING MI
48823-4921
US

IV. Provider business mailing address

1504 E GRAND RIVER AVE SUITE100
EAST LANSING MI
48823-4921
US

V. Phone/Fax

Practice location:
  • Phone: 517-908-3040
  • Fax: 517-908-0856
Mailing address:
  • Phone: 517-908-3040
  • Fax: 517-908-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number4301051137
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: