Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 4301067487 | MI |
NPI | 1013959113 |
---|---|
Provider Name | Dr. Elizabeth C. Smith |
First Address | West Bloomfield, MI 48322 |
Second Address | West Bloomfield, MI 48322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 11/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11289153 | CAQH (01) | |
H12163 | (02) |