MEDICARE: DWIGHT E SMITH, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003849753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DWIGHT E SMITH, MD, PC

Provider Business Mailing Address
First Line	:	PO BOX 23088
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-0088
Country	:	US
Telephone Number	:	313-535-0900
Fax Number	:	313-535-3810

Provider Business Practice Location Address
First Line	:	7800 W OUTER DR
Second Line	:	SUITE 230
City	:	DETROIT
State	:	MI
Zip	:	48235-3461
Country	:	US
Telephone Number	:	313-535-0900
Fax Number	:	313-535-3810

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	DR. DWIGHT ERIC SMITH
Credential	:	MD
Telephone Number	:	313-535-0900

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	12/10/2009

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