MEDICARE: PETER TRENT SMITH MD PC

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	2084P0800X	Psychiatry Physician	4301053454	MI

General Provider Information

NPI Number	:	1548275241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER TRENT SMITH MD PC

Provider Business Mailing Address
First Line	:	3410 E 12 MILE RD STE B
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2593
Country	:	US
Telephone Number	:	586-383-0920
Fax Number	:	586-920-2503

Provider Business Practice Location Address
First Line	:	3410 E 12 MILE RD STE B
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2593
Country	:	US
Telephone Number	:	586-383-0920
Fax Number	:	586-920-2503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER TRENT SMITH
Credential	:	M.D.
Telephone Number	:	586-383-0920

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/01/2022

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