Provider Demographics
NPI:1669629408
Name:SMITH, AUDRA MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6255 UNIVERSITY AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3485
Mailing Address - Country:US
Mailing Address - Phone:608-831-8086
Mailing Address - Fax:608-442-0126
Practice Address - Street 1:6255 UNIVERSITY AVE
Practice Address - Street 2:STE 204
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3485
Practice Address - Country:US
Practice Address - Phone:608-831-8086
Practice Address - Fax:608-442-0126
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016.005415213ES0103X
IA000841213ES0103X
WI1006-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery