Individual
MICHAEL ROBERT SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4422 3RD AVE, BRONX, NY 10457-2545
(718) 960-6507
Mailing address
4422 3RD AVE, BRONX, NY 10457-2545
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
76399
WI
208600000X
Surgery Physician
Primary
DO21431516
OR
208600000X
Surgery Physician
OS018962
PA
2086S0127X
Trauma Surgery Physician
DO214315
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/25/2012
Last updated
08/06/2025
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