Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 5901001917 | MI |
NPI | 1407813413 |
---|---|
Provider Name | Dr. Jan E. Smolen |
First Address | Muskegon, MI 49444-3719 |
Second Address | Muskegon, MI 49444-3719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 09/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133524970 | (05) | MI |
4856110650 | BLUE CROSS BLUE SHIELD (01) | MI |
U77599 | (02) | MI |