Provider Demographics
NPI:1255333514
Name:SMITH, AMY L (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:44555 WOODWARD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5033
Mailing Address - Country:US
Mailing Address - Phone:248-334-4931
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE STE 203
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5033
Practice Address - Country:US
Practice Address - Phone:248-334-4931
Practice Address - Fax:248-239-0492
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072645207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00180522OtherMEDICARE RAILROAD
MIP00180522OtherMEDICARE RAILROAD
MIH76427Medicare UPIN