Individual
KIRK ELLIS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5005 KILKERRY DR, MIDDLETOWN, OH 45042-3004
(937) 641-0447
Mailing address
5005 KILKERRY DR, MIDDLETOWN, OH 45042-3004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34004607
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000016049
ANTHEM
OH
01
—
0120017
UHC
OH
05
—
0764801
—
OH
Enumeration date
08/09/2006
Last updated
09/05/2023
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