Provider Demographics
NPI:1558066290
Name:SMIGELL, JASON PAUL
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:SMIGELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10219 HALEY LN APT 201
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8299
Mailing Address - Country:US
Mailing Address - Phone:810-355-8137
Mailing Address - Fax:
Practice Address - Street 1:1169 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9674
Practice Address - Country:US
Practice Address - Phone:734-220-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator