Individual
CHARLES K SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-3944
(216) 286-6341
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-057479
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000135272
ANTHEM
OH
01
—
000000224156
UNISON
—
01
—
000000530398
ANTHEM
OH
01
—
0634677
AETNA
OH
05
—
0753822
—
OH
01
—
364029
WELLCARE
—
01
—
737694
BUCKEYE
—
01
—
80044873
RAILROAD MEDICARE
OH
Enumeration date
07/18/2006
Last updated
08/29/2011
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