Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 04-25845 | KS |
NPI | 1013993955 |
---|---|
Provider Name | Dr. Michael L Smith |
First Address | Topeka, KS 66606-2442 |
Second Address | Topeka, KS 66606-2442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 21/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068002051 | MEDICARE PTAN (01) | KS |
100189030B | (05) | KS |
G26356 | (02) | KS |