Provider Demographics
NPI:1013961903
Name:SMITH, ROBERT F (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6701
Mailing Address - Country:US
Mailing Address - Phone:734-362-5100
Mailing Address - Fax:734-362-5147
Practice Address - Street 1:19020 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6701
Practice Address - Country:US
Practice Address - Phone:734-362-5100
Practice Address - Fax:734-362-5147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI191369OtherUHC
MI3221613Medicaid
MI4033969OtherAETNA
MI5101006232OtherPHYSICIAN LICENSE
MI125101OtherMERCY CARE CHOICES
MIC4391OtherMCARE
MICC33713OtherRR MEDICARE
MI4611043OtherCIGNA
MI700H21076OtherBCBSM
MI4611043OtherCIGNA