MEDICARE: ANDRE' D SMITH BS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1982249140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE' D SMITH BS

Provider Business Mailing Address
First Line	:	5917 SECOR RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-1423
Country	:	US
Telephone Number	:	330-770-3393
Fax Number	:

Provider Business Practice Location Address
First Line	:	13110 SHAKER SQ STE C200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2373
Country	:	US
Telephone Number	:	330-770-3393
Fax Number	:	216-370-3192

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

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	03/28/2022

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