Provider Demographics
NPI:1578120549
Name:SMITH, SCOTTI DELAINE (MD)
Entity type:Individual
Prefix:
First Name:SCOTTI
Middle Name:DELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 CADIEUX RD, BEAUMONT GROSSE POINTE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230
Mailing Address - Country:US
Mailing Address - Phone:248-712-4266
Mailing Address - Fax:
Practice Address - Street 1:16815 E. JEFFERSON COREWELL HEALTH BEAUMONT FAMILY MEDI
Practice Address - Street 2:SUITE 120
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230
Practice Address - Country:US
Practice Address - Phone:586-498-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2024-07-10
Deactivation Date:2024-05-23
Deactivation Code:
Reactivation Date:2024-06-05
Provider Licenses
StateLicense IDTaxonomies
MI4351053040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine