Healthcare Provider Details

I. General information

NPI: 1568626406
Provider Name (Legal Business Name): STACIE ANNICE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W CENTRAL AVE FL 3
TOLEDO OH
43606-3834
US

IV. Provider business mailing address

2150 W CENTRAL AVE FL 3
TOLEDO OH
43606-3834
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3221
  • Fax:
Mailing address:
  • Phone: 419-291-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301509001
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301509001
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.152463
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: