Provider Demographics
NPI:1366651457
Name:SMITH, EKRAM M (MD)
Entity Type:Individual
Prefix:
First Name:EKRAM
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:208 N SHIAWASSEE ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2755
Mailing Address - Country:US
Mailing Address - Phone:989-723-9796
Mailing Address - Fax:989-729-4032
Practice Address - Street 1:208 N SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2755
Practice Address - Country:US
Practice Address - Phone:989-723-9796
Practice Address - Fax:989-729-4032
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366651457Medicaid
MI0C36019149Medicare PIN