Provider Demographics
NPI:1073502928
Name:SMITH, CHERYL L (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:23050 WEST RD
Practice Address - Street 2:SUITE 260
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1472
Practice Address - Country:US
Practice Address - Phone:734-671-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841564788OtherGROUP NPI HENRY FORD WYANDOTTE
MI114351229Medicaid
MI0H27501OtherBLUE CROSS
1841564788OtherGROUP NPI HENRY FORD WYANDOTTE
MIH50323Medicare UPIN
MI0858208025OtherBCBSMI INDIVIDUAL PIN
MI114351229Medicaid
MI7160324OtherAETNA
MIH50323Medicare UPIN