Provider Demographics
NPI:1649408451
Name:SMART, CHARLES EUGENE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EUGENE
Last Name:SMART
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 1:2811 CHARTER DR
Mailing Address - Street 2:#206
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1323
Mailing Address - Country:US
Mailing Address - Phone:248-312-8193
Mailing Address - Fax:
Practice Address - Street 1:2811 CHARTER DR
Practice Address - Street 2:#206
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1323
Practice Address - Country:US
Practice Address - Phone:248-312-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044281207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology