Individual
DR. KINIM I SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3817 MCMASTERS AVE, SUITE 150, HANNIBAL, MO 63401-2488
(573) 221-0304
(573) 221-0308
Mailing address
3817 MCMASTERS AVE, SUITE 150, HANNIBAL, MO 63401-2488
(573) 221-0304
(573) 221-0308
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
119287
MO
207R00000X
Internal Medicine Physician
119287
MO
207RR0500X
Rheumatology Physician
Primary
119287
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000095293
MEDICARE PTAN
MO
05
—
204666317
—
MO
01
—
MA1381
MEDICARE PTAN
MO
Enumeration date
08/15/2006
Last updated
12/01/2015
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