Provider Demographics
NPI:1245238989
Name:SMITH, THOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8950 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8599
Mailing Address - Country:US
Mailing Address - Phone:231-775-2493
Mailing Address - Fax:231-775-2570
Practice Address - Street 1:8950 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8599
Practice Address - Country:US
Practice Address - Phone:231-775-2493
Practice Address - Fax:231-775-2570
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS048898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2904151Medicaid
MI103493OtherPREFERRED CHOICES
MI080H376070OtherGROUP BCBS
MI0808300031OtherINDIVIDUAL BCBS
MIA77982Medicare UPIN
MI080099404Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI2904151Medicaid
MIN27000-001Medicare ID - Type Unspecified
MI080H376070OtherGROUP BCBS