MEDICARE: JENNIFER KRISTA SMITH DO

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	207V00000X	Obstetrics & Gynecology Physician	5101014655	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
2	300207909	OTHER	MI	TAX ID

General Provider Information

NPI Number	:	1558363424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KRISTA SMITH DO

Provider Business Mailing Address
First Line	:	35000 FORD RD
Second Line	:	SUITE 3
City	:	WESTLAND
State	:	MI
Zip	:	48185-3719
Country	:	US
Telephone Number	:	734-721-4700
Fax Number	:	734-721-9186

Provider Business Practice Location Address
First Line	:	35000 FORD RD
Second Line	:	SUITE 3
City	:	WESTLAND
State	:	MI
Zip	:	48185-3719
Country	:	US
Telephone Number	:	734-721-4700
Fax Number	:	734-721-9186

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/06/2008

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