Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101021779 | MI |
N | 111NI0900X | Internist | 5101021779 | MI |
Y | 207RC0200X | Critical Care Medicine | 5101026086 | MI |
N | 207RP1001X | Pulmonary Disease | 5101026086 | MI |
NPI | 1093195430 |
---|---|
Provider Name | Eric John Smith |
First Address | Battle Creek, MI 49017-3395 |
Second Address | Battle Creek, MI 49017-3395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 06/07/2021 |