Provider Demographics
NPI:1104934603
Name:SMITH, RICK JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:JOEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1504 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4921
Mailing Address - Country:US
Mailing Address - Phone:517-908-3040
Mailing Address - Fax:517-908-0856
Practice Address - Street 1:1504 E GRAND RIVER AVE
Practice Address - Street 2:SUITE100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4921
Practice Address - Country:US
Practice Address - Phone:517-908-3040
Practice Address - Fax:517-908-0856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010511372082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13 00007OtherPHP OF MID MICHIGAN
MI13 70017OtherPHP FAMILY CARE
MI2403303571OtherBCBS OF MICHIGAN
MI3160115Medicaid
MI0330357Medicare ID - Type Unspecified
MI13 00007OtherPHP OF MID MICHIGAN