Healthcare Provider Details

I. General information

NPI: 1598325177
Provider Name (Legal Business Name): RACHAEL SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 SILVER PKWY STE D
FENTON MI
48430-3468
US

IV. Provider business mailing address

6198 EWALT RD
IMLAY CITY MI
48444-8917
US

V. Phone/Fax

Practice location:
  • Phone: 810-208-0378
  • Fax:
Mailing address:
  • Phone: 517-249-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003129
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: