Healthcare Provider Details

I. General information

NPI: 1528227709
Provider Name (Legal Business Name): REBECCA MARIE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MARIE PALACIOS

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 EAST CIRCLE DRIVE
EAST LANSING MI
48824-1037
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-6503
  • Fax: 517-355-9265
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301101982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: