Provider Demographics
NPI:1356894943
Name:SMITH, METECIA
Entity type:Individual
Prefix:
First Name:METECIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11138 FINDLAY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-4714
Mailing Address - Country:US
Mailing Address - Phone:313-433-3621
Mailing Address - Fax:313-922-4689
Practice Address - Street 1:11138 FINDLAY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-4714
Practice Address - Country:US
Practice Address - Phone:313-433-3621
Practice Address - Fax:313-922-4689
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor