Organization
MARK B. SMUCKLER MD LTD
Active
Parent organization
MARK B. SMUCKLER MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARK B. SMUCKLER MD
Authorized official
DR. MARK B SMUCKLER M.D. (PRESIDENT)
(414) 332-2450
Entity
Organization
Contact information
Practice address
155 E SILVER SPRING DR, 203, MILWAUKEE, WI 53217-4704
(414) 332-2450
(414) 332-1390
Mailing address
155 E SILVER SPRING DR, 203, MILWAUKEE, WI 53217-4704
(414) 332-2450
(414) 332-1390
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
16139
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
16139
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30954800
—
WI
Enumeration date
10/31/2011
Last updated
10/31/2011
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