Provider Demographics
NPI:1437242070
Name:SMITH, CRAIG SHEPHERD (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:SHEPHERD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 N. MACOMB
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161
Mailing Address - Country:US
Mailing Address - Phone:734-240-8400
Mailing Address - Fax:
Practice Address - Street 1:718 N. MACOMB
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161
Practice Address - Country:US
Practice Address - Phone:734-240-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010466132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4349973OtherMOLINA HEALTHCARE
MI4349973Medicaid
MI29807OtherCOMMUNITY CHOICE OF MI
MI4349973OtherHEALTHPLAN OF MI
MIB48861Medicare UPIN