Provider Demographics
NPI:1801478292
Name:TROUT-SMITH, MADELINE SOPHIA (DO)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:SOPHIA
Last Name:TROUT-SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:SOPHIA
Other - Last Name:TROUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1319 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-3215
Practice Address - Country:US
Practice Address - Phone:404-552-3222
Practice Address - Fax:402-552-2172
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine