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Individual

MICHAEL J SMITH

Active
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Individual

MICHAEL J SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01063120
IN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
036141508
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000517783
ANTHEM
IN
05
200858510
IN
Enumeration date
07/15/2005
Last updated
03/23/2017
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