Provider Demographics
NPI:1366434490
Name:SMITH, JUDIAN H (MD)
Entity type:Individual
Prefix:
First Name:JUDIAN
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:702 N BLACKHAWK AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3357
Mailing Address - Country:US
Mailing Address - Phone:608-663-5926
Mailing Address - Fax:608-663-5928
Practice Address - Street 1:702 N BLACKHAWK AVE
Practice Address - Street 2:STE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3357
Practice Address - Country:US
Practice Address - Phone:608-663-5926
Practice Address - Fax:608-663-5928
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25712-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B56703Medicare UPIN
000074399Medicare ID - Type Unspecified