Provider Demographics
NPI:1336431287
Name:SMITH, EMILY ROSE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:MATERNAL AND FETAL MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6625
Mailing Address - Fax:414-805-9000
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:MATERNAL AND FETAL MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6625
Practice Address - Fax:414-805-9000
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI69664207VM0101X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1336431287Medicaid