Healthcare Provider Details

I. General information

NPI: 1225415169
Provider Name (Legal Business Name): DAVID MICHAEL SMEENGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37595 7 MILE RD STE 230
LIVONIA MI
48152
US

IV. Provider business mailing address

37595 7 MILE RD STE 230
LIVONIA MI
48152-1003
US

V. Phone/Fax

Practice location:
  • Phone: 734-853-5694
  • Fax:
Mailing address:
  • Phone: 734-853-5694
  • Fax:

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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301114052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: