Provider Demographics
NPI:1881708477
Name:ELIZABETH C SMITH MD PC
Entity type:Organization
Organization Name:ELIZABETH C SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-855-0077
Mailing Address - Street 1:5777 W MAPLE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2267
Mailing Address - Country:US
Mailing Address - Phone:248-855-0077
Mailing Address - Fax:248-855-0042
Practice Address - Street 1:5777 W MAPLE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2267
Practice Address - Country:US
Practice Address - Phone:248-855-0077
Practice Address - Fax:248-855-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010674872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP31350001Medicare ID - Type UnspecifiedSMITH, M.D. P.C.
MIOP31350Medicare ID - Type UnspecifiedSMITH INDIVIDUAL
MIH12163Medicare UPIN