MEDICARE: AMY L SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301072645	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00180522	OTHER	MI	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1255333514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L SMITH MD

Provider Business Mailing Address
First Line	:	44555 WOODWARD AVE STE 203
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-5033
Country	:	US
Telephone Number	:	248-334-4931
Fax Number	:

Provider Business Practice Location Address
First Line	:	44555 WOODWARD AVE STE 203
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-5033
Country	:	US
Telephone Number	:	248-334-4931
Fax Number	:	248-239-0492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/16/2022

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Directions to “ AMY L SMITH MD” Practice Location

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