Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 41086 | KY |
Y | 2080P0208X | Pediatric Infectious Diseases | 41086 | KY |
NPI | 1336340454 |
---|---|
Provider Name | Dr. Michael Joseph Smith |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200890490 | (05) | IN |
7100021340 | (05) | KY |