Healthcare Provider Details

I. General information

NPI: 1912838426
Provider Name (Legal Business Name): KIRK ALLEN SMALLEGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E KEARSLEY ST
FLINT MI
48502-1950
US

IV. Provider business mailing address

9343 W WATERGATE RD APT 17
MC BAIN MI
49657-9663
US

V. Phone/Fax

Practice location:
  • Phone: 231-429-9140
  • Fax:
Mailing address:
  • Phone: 231-429-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704389634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: