Provider Demographics
NPI:1073722146
Name:SMITH, TIMEKA
Entity Type:Individual
Prefix:
First Name:TIMEKA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 PENROD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1832
Mailing Address - Country:US
Mailing Address - Phone:313-794-0841
Mailing Address - Fax:
Practice Address - Street 1:1475 E OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1265
Practice Address - Country:US
Practice Address - Phone:313-369-8578
Practice Address - Fax:313-371-1409
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist