MEDICARE: DR. ANN TIMMERMANN SMITH M.D.

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	208000000X	Pediatrics Physician	4301055435	MI

General Provider Information

NPI Number	:	1346485505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN TIMMERMANN SMITH M.D.

Provider Business Mailing Address
First Line	:	7835 TRUESDALE LANE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-1667
Country	:	US
Telephone Number	:	231-631-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	7835 TRUESDALE LANE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-1667
Country	:	US
Telephone Number	:	231-631-0411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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