Healthcare Provider Details

I. General information

NPI: 1346241668
Provider Name (Legal Business Name): LAURA FOX-SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 KERCHEVAL AVE STE 205 BEAUMONT GROSSE POINTE PHYSICIANS & SURGEONS
GROSSE POINTE MI
48230-1570
US

IV. Provider business mailing address

130 TOWN CENTER DR STE 203 BEAUMONT MEDICAL STAFF AFFAIRS
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 313-640-2424
  • Fax: 313-640-2415
Mailing address:
  • Phone: 248-585-8218
  • Fax: 248-585-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301050430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: