Provider Demographics
NPI:1669866505
Name:SMOLCICH, ABBY L (MD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:L
Last Name:SMOLCICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:L
Other - Last Name:CALLAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5794
Mailing Address - Country:US
Mailing Address - Phone:920-996-3264
Mailing Address - Fax:920-830-5970
Practice Address - Street 1:W5282 AMY AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7233
Practice Address - Country:US
Practice Address - Phone:920-358-1900
Practice Address - Fax:920-358-1909
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI66612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program