MEDICARE: LAURA ANN SMITH D.O.

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	208000000X	Pediatrics Physician	50311-021	WI

General Provider Information

NPI Number	:	1811977929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN SMITH D.O.

Provider Business Mailing Address
First Line	:	3085 MEADOWLARK LN
Second Line	:	STE 20
City	:	ALTOONA
State	:	WI
Zip	:	54720-2656
Country	:	US
Telephone Number	:	715-717-3350
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 MEADOWLARK LN STE 20
Second Line	:
City	:	ALTOONA
State	:	WI
Zip	:	54720
Country	:	US
Telephone Number	:	715-717-3350
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	08/07/2018

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