Healthcare Provider Details

I. General information

NPI: 1922078450
Provider Name (Legal Business Name): TROY MERRILL SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38253 ANN ARBOR RD
LIVONIA MI
48150-3432
US

IV. Provider business mailing address

38253 ANN ARBOR RD
LIVONIA MI
48150-3432
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-9200
  • Fax: 734-464-3332
Mailing address:
  • Phone: 734-464-9200
  • Fax: 734-464-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: