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General NPI Number Information
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NPI Number | 1568626406
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Entity Type | Individual
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Provider Name | STACIE ANNICE SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 2150 W CENTRAL AVE FL 3
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City | TOLEDO
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State | OH
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Zip | 43606-3834
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Country | US
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Telephone | 419-291-3221
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 W CENTRAL AVE FL 3
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City | TOLEDO
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State | OH
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Zip | 43606-3834
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Country | US
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Telephone | 419-291-3221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 4301509001
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 4301509001
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 35.152463
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License Number State | OH
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