Healthcare Provider Details

I. General information

NPI: 1669571444
Provider Name (Legal Business Name): ELAINE C SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21258 M 68 HWY
ONAWAY MI
49765-9692
US

IV. Provider business mailing address

PO BOX 427
HILLMAN MI
49746-0427
US

V. Phone/Fax

Practice location:
  • Phone: 989-733-2082
  • Fax: 989-733-8487
Mailing address:
  • Phone: 989-354-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: