Individual
DR. MICHAEL A. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1255
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-114524
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
279500
MEDICARE GROUP
—
01
—
P00395963
RAILROAD MEDICARE
—
Enumeration date
08/04/2006
Last updated
01/05/2022
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