Provider Demographics
NPI:1346250578
Name:SMYLNYCKY, AGNIESZKA Z (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:Z
Last Name:SMYLNYCKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2891 E MAPLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6106
Mailing Address - Country:US
Mailing Address - Phone:248-635-5988
Mailing Address - Fax:485-249-0862
Practice Address - Street 1:2891 E MAPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6106
Practice Address - Country:US
Practice Address - Phone:248-524-9085
Practice Address - Fax:248-524-9086
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301080644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104949279Medicaid
MII69112Medicare UPIN
MI104949279Medicaid