Basic Information
| Provider Information | |||||||||
| NPI: | 1003005315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | BRYANT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4977 SKYVIEW CT | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496846941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314216599 | ||||||||
| FaxNumber: | 2314216602 | ||||||||
| Practice Location | |||||||||
| Address1: | 4977 SKYVIEW CT | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496846941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314216599 | ||||||||
| FaxNumber: | 2314216602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0122X | 036123693 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.