Provider Demographics
NPI:1922168574
Name:SMERZ, PAUL MARLIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARLIN
Last Name:SMERZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4308
Mailing Address - Country:US
Mailing Address - Phone:414-962-1000
Mailing Address - Fax:414-963-6866
Practice Address - Street 1:6110 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4308
Practice Address - Country:US
Practice Address - Phone:414-332-7400
Practice Address - Fax:414-963-6866
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1242-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39044000Medicaid
WI000144945Medicare PIN
WI39044000Medicaid