Individual
CAROLYN SHANNON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
545 N 15TH ST, MILWAUKEE, WI 53233-2237
(414) 288-7184
Mailing address
240 W INDIAN CREEK CT, MILWAUKEE, WI 53217-2323
(414) 540-6593
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
38125
WI
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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