MEDICARE: RONALD L. SMITS M.D.

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	207N00000X	Dermatology Physician	17488-020	WI

General Provider Information

NPI Number	:	1851315733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD L. SMITS M.D.

Provider Business Mailing Address
First Line	:	6233 BANKERS RD
Second Line	:	STE 3
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-9700
Country	:	US
Telephone Number	:	262-898-4400
Fax Number	:	262-898-4423

Provider Business Practice Location Address
First Line	:	6233 BANKERS RD
Second Line	:	STE 3
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-9700
Country	:	US
Telephone Number	:	262-898-4400
Fax Number	:	262-898-4423

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/13/2014

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