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NPI Code Detail

MEDICARE: IVAN SMITH

MEDICARE: IVAN SMITH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1831053735
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN SMITH
Provider Business Mailing Address
First Line : 5111 AUTO CLUB DR
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2749
Country : US
Telephone Number : 313-406-5056
Fax Number :
Provider Business Practice Location Address
First Line : 19853 OUTER DR
Second Line :
City : DEARBORN
State : MI
Zip : 48124-2066
Country : US
Telephone Number : 313-406-5056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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Directions to “ IVAN SMITH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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