Provider Demographics
NPI:1932266251
Name:SIDNEY J SMITH MD PC
Entity Type:Organization
Organization Name:SIDNEY J SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-457-3340
Mailing Address - Street 1:1086 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3193
Mailing Address - Country:US
Mailing Address - Phone:734-457-3340
Mailing Address - Fax:734-457-3910
Practice Address - Street 1:1086 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3193
Practice Address - Country:US
Practice Address - Phone:734-457-3340
Practice Address - Fax:734-457-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1605823141OtherBLUE CROSS BLUE SHIELD
MI1605823141OtherBLUE CARE NETWORK
MI1605823141OtherBLUE CROSS BLUE SHIELD
MI0P31390Medicare PIN