Provider Demographics
NPI:1821017740
Name:SMIT, RENE (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:SMIT
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 1:1005 RIVER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3468
Mailing Address - Country:US
Mailing Address - Phone:810-982-6720
Mailing Address - Fax:810-982-6026
Practice Address - Street 1:1005 RIVER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3468
Practice Address - Country:US
Practice Address - Phone:810-982-6720
Practice Address - Fax:810-982-6026
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0740733Medicare ID - Type Unspecified