Healthcare Provider Details

I. General information

NPI: 1205036654
Provider Name (Legal Business Name): DONNA DEYOUNG SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3688 EATON GATE LN
AUBURN HILLS MI
48326-3892
US

IV. Provider business mailing address

3688 EATON GATE LN
AUBURN HILLS MI
48326-3892
US

V. Phone/Fax

Practice location:
  • Phone: 248-853-6613
  • Fax:
Mailing address:
  • Phone: 248-853-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number4301066696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: