Healthcare Provider Details

I. General information

NPI: 1801980636
Provider Name (Legal Business Name): ANDRE LEO SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 MAYFIELD RD STE 320-323
MAYFIELD HTS OH
44124-2299
US

IV. Provider business mailing address

6770 MAYFIELD RD STE 320-323
MAYFIELD HTS OH
44124-2299
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-7140
  • Fax: 440-312-7142
Mailing address:
  • Phone: 440-312-7140
  • Fax: 440-312-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35-067343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: