Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101240233 | VA |
N | 208000000X | Pediatrician | 2018039282 | MO |
Y | 2080P0214X | Pediatric Pulmonologist | 2018039282 | MO |
NPI | 1295816841 |
---|---|
Provider Name | Dr. Michael Robert Smiley |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 18/01/2021 |