MEDICARE: RACHAEL SMITH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601003129	MI
2	363A00000X	Physician Assistant	5601003129	MI

General Provider Information

NPI Number	:	1598325177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL SMITH PA-C

Provider Business Mailing Address
First Line	:	6198 EWALT RD
Second Line	:
City	:	IMLAY CITY
State	:	MI
Zip	:	48444-8917
Country	:	US
Telephone Number	:	517-249-2826
Fax Number	:

Provider Business Practice Location Address
First Line	:	17100 SILVER PKWY STE D
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3468
Country	:	US
Telephone Number	:	810-208-0378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	06/24/2026

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Directions to “ RACHAEL SMITH PA-C” Practice Location

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