Provider Demographics
NPI:1952347155
Name:SMITH, CHRISTOPHER PERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PERRY
Last Name:SMITH
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 1:501 SOUTH DRAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3234
Mailing Address - Country:US
Mailing Address - Phone:269-343-1296
Mailing Address - Fax:269-344-8485
Practice Address - Street 1:501 SOUTH DRAKE ROAD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3234
Practice Address - Country:US
Practice Address - Phone:269-343-1296
Practice Address - Fax:269-344-8485
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085348207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040C910710OtherBCBS GRP PIN
5983218OtherAETNA PIN
MI0403912021OtherBCBS IND PIN
155430OtherGREAT LAKES HLTH PLN
MI4810330-10Medicaid
MI4810330-10Medicaid
5983218OtherAETNA PIN
155430OtherGREAT LAKES HLTH PLN
MI4810330-10Medicaid
MICA3050Medicare PIN