Individual
SHANNON O SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9037 SETTLERS RD, MADISON, WI 53717-2730
(608) 228-4585
Mailing address
9037 SETTLERS RD, MADISON, WI 53717-2730
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
53192
WI
207R00000X
Internal Medicine Physician
Primary
53192
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102430
—
IL
01
—
3715468
BC/BS
IL
Enumeration date
08/31/2006
Last updated
09/20/2023
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