Provider Demographics
NPI:1548250400
Name:SMITH, JOANN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36880 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0919
Mailing Address - Country:US
Mailing Address - Phone:248-642-7710
Mailing Address - Fax:248-642-1443
Practice Address - Street 1:36880 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0919
Practice Address - Country:US
Practice Address - Phone:248-642-7710
Practice Address - Fax:248-642-1443
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06145Medicare UPIN
OM00310Medicare ID - Type Unspecified