Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101020355 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5101020355 | MI |
NPI | 1043655012 |
---|---|
Provider Name | Emily Clare-Showerman Smith |
First Address | Grand Ledge, MI 48837-2293 |
Second Address | Grand Ledge, MI 48837-2293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 18/03/2021 |