Provider Demographics
NPI:1700812443
Name:SMETHURST, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SMETHURST
Suffix:
Gender:F
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1715 INDIAN WOOD CIR
Practice Address - Street 2:STE 200, OFFICE 266 & 255
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4055
Practice Address - Country:US
Practice Address - Phone:419-578-8594
Practice Address - Fax:855-618-2622
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050480207Q00000X
MI4301051752208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00066885OtherRAILROAD
OH0590123Medicaid
OH9308733Medicare PIN