Provider Demographics
NPI:1588838460
Name:ANDREW SMITH, M.D., P.C.
Entity Type:Organization
Organization Name:ANDREW SMITH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:517-264-5011
Mailing Address - Street 1:1548 W MAUMEE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1382
Mailing Address - Country:US
Mailing Address - Phone:517-264-5011
Mailing Address - Fax:517-265-8572
Practice Address - Street 1:1548 W MAUMEE ST
Practice Address - Street 2:SUITE G
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1382
Practice Address - Country:US
Practice Address - Phone:517-264-5011
Practice Address - Fax:517-265-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040069207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958908Medicaid
MID38230Medicare UPIN
MI04657565162Medicare PIN