Provider Demographics
NPI:1013383892
Name:SMITH, MICHAEL G (PA-C)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:G
Last Name:SMITH
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1218 SOUTH BROADWAY
Mailing Address - Street 2:STE 310
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2759
Mailing Address - Country:US
Mailing Address - Phone:859-219-0542
Mailing Address - Fax:859-219-9433
Practice Address - Street 1:1218 SOUTH BROADWAY
Practice Address - Street 2:STE 310
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2759
Practice Address - Country:US
Practice Address - Phone:859-219-0542
Practice Address - Fax:859-219-9433
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant