Provider Demographics
NPI:1407813413
Name:SMOLEN, JAN E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:E
Last Name:SMOLEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3719
Mailing Address - Country:US
Mailing Address - Phone:231-733-1111
Mailing Address - Fax:231-733-1144
Practice Address - Street 1:561 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3719
Practice Address - Country:US
Practice Address - Phone:231-733-1111
Practice Address - Fax:231-733-1144
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001917213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856110650OtherBLUE CROSS BLUE SHIELD
MI133524970Medicaid
MI0F16415004Medicare ID - Type Unspecified
MI133524970Medicaid