Provider Demographics
NPI:1821202409
Name:CHERYL SMITH DO PC
Entity Type:Organization
Organization Name:CHERYL SMITH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-759-0267
Mailing Address - Street 1:14700 KING RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7909
Mailing Address - Country:US
Mailing Address - Phone:734-759-0267
Mailing Address - Fax:734-759-0272
Practice Address - Street 1:14700 KING RD
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7909
Practice Address - Country:US
Practice Address - Phone:734-759-0267
Practice Address - Fax:734-759-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114351229Medicaid
MI7160324OtherAETNA
MI080190734OtherMEDICARE RAILROAD
MI0858208025OtherBCBSMI INDIVIDUAL PIN
MI080H234390OtherBCBSMI GROUP PIN
MI1073502928OtherINDIVIDUAL NPI
MI7160324OtherAETNA
MI1073502928OtherINDIVIDUAL NPI
MI080H234390OtherBCBSMI GROUP PIN