Healthcare Provider Details

I. General information

NPI: 1336431287
Provider Name (Legal Business Name): EMILY ROSE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 10/10/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE MATERNAL AND FETAL MEDICINE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE MATERNAL AND FETAL MEDICINE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6625
  • Fax: 414-805-9000
Mailing address:
  • Phone: 414-805-6625
  • Fax: 414-805-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number69664
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: