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Individual

DWAYNE SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3521 N 53RD ST, MILWAUKEE, WI 53216-2950
(608) 888-3492
Mailing address
1314 S 1ST ST, MILWAUKEE, WI 53204-2405
(608) 888-3492

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1689007932
WI
Enumeration date
10/12/2021
Last updated
10/12/2021
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