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General NPI Number Information
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NPI Number | 1821202409
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Entity Type | Organization
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Legal Business Name | CHERYL SMITH DO PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 14700 KING RD SUITE B
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City | RIVERVIEW
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State | MI
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Zip | 48193-7909
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Country | US
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Telephone | 734-759-0267
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Fax | 734-759-0272
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Provider Business Mailing Address
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Address Line | 14700 KING RD SUITE B
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City | RIVERVIEW
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State | MI
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Zip | 48193-7909
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Country | US
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Telephone | 734-759-0267
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Fax | 734-759-0272
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHERYL L SMITH
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Credential | D.O.
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Telephone | 734-759-0267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101013898
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License Number State | MI
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