=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922078450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TROY MERRILL SMITH DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2006
-----------------------------------------------------
Last Update Date | 03/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38253 ANN ARBOR RD
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-464-9200
-----------------------------------------------------
Fax | 734-464-3332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38253 ANN ARBOR RD
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-3432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-464-9200
-----------------------------------------------------
Fax | 734-464-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101011031
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------