Provider Demographics
NPI:1417646571
Name:SMITH, ALEXIS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48621-8731
Mailing Address - Country:US
Mailing Address - Phone:989-848-5644
Mailing Address - Fax:989-318-4606
Practice Address - Street 1:1910 E MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MI
Practice Address - Zip Code:48621-8731
Practice Address - Country:US
Practice Address - Phone:989-848-5644
Practice Address - Fax:989-318-4606
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant