Healthcare Provider Details

I. General information

NPI: 1528155850
Provider Name (Legal Business Name): DON OSCAR SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/14/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 W WALTON BLVD
WATERFORD MI
48329-4905
US

IV. Provider business mailing address

41313 ALTISSIMO DR
CLINTON TOWNSHIP MI
48038-4998
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-3920
  • Fax:
Mailing address:
  • Phone: 248-205-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0055555
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301066484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: