Healthcare Provider Details

I. General information

NPI: 1356778286
Provider Name (Legal Business Name): DONALD SMITH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 1645
BINGHAM FARMS MI
48025-4525
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-5000
  • Fax:
Mailing address:
  • Phone: 248-283-1100
  • Fax: 248-283-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301048619
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number4301048619
License Number StateMI

VIII. Authorized Official

Name: DR. DONALD B SMITH JR.
Title or Position: OWNER
Credential: MD
Phone: 248-283-1100