Healthcare Provider Details

I. General information

NPI: 1245595123
Provider Name (Legal Business Name): JAMES EDWARD SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2012
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE # MC49
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC49
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-732-6200
  • Fax:
Mailing address:
  • Phone: 616-732-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301100993
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5315055663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: