Provider Demographics
NPI:1649290685
Name:SMITH, LAUREN S (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:550 E WASHINGTON ST
Mailing Address - Street 2:STE 205
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-2202
Mailing Address - Country:US
Mailing Address - Phone:616-527-8293
Mailing Address - Fax:616-527-5718
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:STE 205
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2202
Practice Address - Country:US
Practice Address - Phone:616-527-8293
Practice Address - Fax:616-527-5718
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MILS059620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4425028OtherMOLINA
MI1016883OtherMCLAREN
MI01349OtherPRIORITY HEALTH PAY TO #
MI200000000811OtherPHPMM
G07764Medicare UPIN