Healthcare Provider Details

I. General information

NPI: 1356838247
Provider Name (Legal Business Name): RICHARD LEROY SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

IV. Provider business mailing address

2222 CHERRY ST STE 2300
TOLEDO OH
43608-2675
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.151934
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301508897
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number4301508897
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35.151934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: