Provider Demographics
NPI:1528155850
Name:SMITH, DON OSCAR (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:OSCAR
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 1:41313 ALTISSIMO DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4998
Mailing Address - Country:US
Mailing Address - Phone:248-205-9130
Mailing Address - Fax:
Practice Address - Street 1:4576 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4905
Practice Address - Country:US
Practice Address - Phone:248-618-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00555552084P0804X
MI43010664842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
183003OtherCOMPSYCH
MD395503600Medicaid
60559404OtherCAREFIRST MD
R5830016OtherCAREFIRST GHMSI
098L33KKMedicare ID - Type Unspecified