Healthcare Provider Details

I. General information

NPI: 1407813413
Provider Name (Legal Business Name): JAN E. SMOLEN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 SEMINOLE RD
MUSKEGON MI
49444-3719
US

IV. Provider business mailing address

561 SEMINOLE RD
MUSKEGON MI
49444-3719
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-1111
  • Fax: 231-733-1144
Mailing address:
  • Phone: 231-733-1111
  • Fax: 231-733-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001917
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: