Provider Demographics
NPI:1427040229
Name:SMITH, DANIELLE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:725 AMERICAN AVE
Mailing Address - Street 2:WAUKESHA MEMORIAL HOSPITAL-HOSPITALIST GROUP
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-928-5400
Mailing Address - Fax:
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:WAUKESHA MEMORIAL HOSPITAL-HOSPITALIST GROUP
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51616-20208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891373JMedicaid
WI35125900OtherTITLE 19 MEDICAID
NC1373JOtherBCBS NC
NC8904701Medicaid
NCH87315Medicare UPIN
NC891373JMedicaid
NC8904701Medicaid