Provider Demographics
NPI:1396713343
Name:SMITH, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ROCHDALE DR S
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2275
Mailing Address - Country:US
Mailing Address - Phone:248-656-0544
Mailing Address - Fax:248-656-1613
Practice Address - Street 1:145 ROCHDALE DR S
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2275
Practice Address - Country:US
Practice Address - Phone:248-656-0544
Practice Address - Fax:248-656-1613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM5034028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3067086Medicaid
A75222OtherALLIANCE HEALTH
1606333511OtherBC
508594OtherCARE CHOICES
A75222OtherHEALTH ALLIANCE
A75222OtherHEALTH ALLIANCE
1606333511OtherBC