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General NPI Number Information
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NPI Number | 1174800411
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Entity Type | Organization
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Legal Business Name | NEW LIFE MEDICAL SENIOR CARE PC
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 105 S WILDWOOD XING APT 20
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City | LUDINGTON
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State | MI
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Zip | 49431-8719
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Country | US
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Telephone | 231-233-1704
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Fax |
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Provider Business Mailing Address
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Address Line | 570 SEMINOLE RD SUITE 200
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City | NORTON SHORES
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State | MI
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Zip | 49444-3749
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Country | US
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Telephone | 231-759-5065
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Fax | 231-780-6090
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL RAY SMALLEY
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Credential | D.O.
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Telephone | 231-233-1704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 5101009049
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License Number State | MI
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