Provider Demographics
NPI:1932127321
Name:SMITH, DEE ANN M (MD)
Entity Type:Individual
Prefix:
First Name:DEE ANN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEE ANN
Other - Middle Name:M
Other - Last Name:HAKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:830 E GREEN BAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-2662
Mailing Address - Country:US
Mailing Address - Phone:262-284-7117
Mailing Address - Fax:
Practice Address - Street 1:830 E GREEN BAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080-2662
Practice Address - Country:US
Practice Address - Phone:262-284-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34082000Medicaid
WI34082000Medicaid