Individual
JANE C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-1000
Mailing address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-1000
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21940
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1004960
PHYSICIANS PLUS
—
01
—
10897
MEDICAID DEAN
—
01
—
13900226
MEDICARE PART B
—
01
—
260021000
MEDICARE RAILROAD
—
01
—
30291100
HIRSP
—
05
—
30291100
—
WI
01
—
390808509
WPS
—
01
—
39080850996
UNITY
—
01
—
690004890
MEDICARE RAILROAD
—
01
—
90002361
WEA INS
—
Enumeration date
10/03/2006
Last updated
12/29/2020
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