Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101016983 | MI |
Y | 207PE0004X | Emergency Medical Services | 5101016983 | MI |
NPI | 1205046174 |
---|---|
Provider Name | Jeffrey Michael Smarse |
First Address | Mount Clemens, MI 48043 |
Second Address | Cass City, MI 48726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 07/03/2013 |