Provider Demographics
NPI:1437223948
Name:SMERECK, SUSAN MARY (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:SMERECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:29200 SCHOOLCRAFT
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150
Mailing Address - Country:US
Mailing Address - Phone:734-523-1050
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:29200 SCHOOLCRAFT
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:734-523-1050
Practice Address - Fax:734-523-2464
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080H262390OtherBLUE CROSS-BLUE CROSS
SS071790OtherCHAMPUS-CHAMPUS
SS071790OtherCOMMERCIAL-COMMERCIAL NUMBER
MI445481610Medicaid
MI445481610Medicaid
080H262390OtherBLUE CROSS-BLUE CROSS