Individual
DR. ANDREW JK SMITH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 PARK NICOLLET BLVD, CREDENTIALING DEPT, ST LOUIS PARK, MN 55416-2527
(952) 993-6450
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING DEPT, ST LOUIS PARK, MN 55416-2527
(952) 993-6450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
41532
MN
207RC0000X
Cardiovascular Disease Physician
Primary
41532
MN
207RC0000X
Cardiovascular Disease Physician
44553
CO
207RC0001X
Clinical Cardiac Electrophysiology Physician
41532
MN
207RC0001X
Clinical Cardiac Electrophysiology Physician
44553
CO
207RI0011X
Interventional Cardiology Physician
44553
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019391
KAISER COMMERCIAL NUMBER
CO
05
—
72735759
—
CO
Enumeration date
05/12/2006
Last updated
07/02/2012
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