MEDICARE: MS. DANIELLE MICHEL SMITH NP

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	363L00000X	Nurse Practitioner	4704194031	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	11712584	OTHER	CAQH
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669450748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE MICHEL SMITH NP

Provider Business Mailing Address
First Line	:	23300 ECORSE RD
Second Line	:
City	:	TAYLOR
State	:	MI
Zip	:	48180-1768
Country	:	US
Telephone Number	:	313-291-9500
Fax Number	:	313-291-6694

Provider Business Practice Location Address
First Line	:	18101 OAKWOOD BLVD
Second Line	:	ISU-OBS
City	:	DEARBORN
State	:	MI
Zip	:	48123-4089
Country	:	US
Telephone Number	:	313-982-5770
Fax Number	:	313-982-5771

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	09/21/2017

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