Individual
DR. MARK B SMUCKLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
155 E SILVER SPRING DR, 203, MILWAUKEE, WI 53217-4704
(414) 332-2450
(414) 332-1390
Mailing address
155 EAST SILVER SPRING DRIVE, 203, MILWAUKEE, WI 53217
(414) 332-2450
(414) 332-1390
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
16139
WI
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
16139
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30954800
—
WI
Enumeration date
10/25/2006
Last updated
10/11/2011
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