Organization
ANDREW J SMITH JR MD MEMORIAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J GWENDOLYN GORDON (MD)
(248) 424-8888
Entity
Organization
Contact information
Practice address
23077 GREENFIELD RD, STE 200, SOUTHFIELD, MI 48075-3709
(248) 424-8888
Mailing address
23077 GREENFIELD RD, STE 200, SOUTHFIELD, MI 48075-3709
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
EC066609
MI
174400000X
Specialist
Primary
JG023085
MI
174400000X
Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
450374110
—
MI
05
—
451303110
—
MI
Enumeration date
04/10/2007
Last updated
03/06/2009
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