Provider Demographics
NPI:1770529455
Name:SMITH, JAMES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST STE M-206C
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5359
Mailing Address - Country:US
Mailing Address - Phone:855-618-2676
Mailing Address - Fax:269-488-8284
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-230
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-349-8601
Practice Address - Fax:269-349-6446
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039031207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2999235-10Medicaid
109248OtherGREAT LAKES HLTH PLN
MI1770529455Medicaid
MI3403900580OtherBCBS IND PIN
MA200C910540OtherBCBS GRP PIN
5010702OtherAETNA PIN
5010702OtherAETNA PIN
MI3403900580OtherBCBS IND PIN
MA200C910540OtherBCBS GRP PIN
MI0C97625020Medicare ID - Type Unspecified
MICI5823Medicare PIN
109248OtherGREAT LAKES HLTH PLN