Healthcare Provider Details

I. General information

NPI: 1659786275
Provider Name (Legal Business Name): ENI SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25235 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336-1233
US

IV. Provider business mailing address

25235 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336-1233
US

V. Phone/Fax

Practice location:
  • Phone: 248-802-1589
  • Fax:
Mailing address:
  • Phone: 248-802-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number62126
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301500764
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number4301500764
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: