Provider Demographics
NPI:1235203779
Name:SMITH, EMILY D (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:STE. 403
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5360
Mailing Address - Country:US
Mailing Address - Phone:248-559-1911
Mailing Address - Fax:248-559-1912
Practice Address - Street 1:20905 GREENFIELD RD
Practice Address - Street 2:STE. 403
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5360
Practice Address - Country:US
Practice Address - Phone:248-559-1911
Practice Address - Fax:248-559-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF95111Medicare UPIN