Provider Demographics
NPI:1306829155
Name:SMITH, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4551
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL236442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555898Medicaid
AL247930Medicaid
AL249669Medicaid
AL51595731OtherBCBS
AL212000Medicaid
AL238647Medicaid
AL248524Medicaid
AL51067184OtherBCBS
AL009942787Medicaid
AL127006Medicaid
AL51595733OtherBCBS
AL248559Medicaid
AL248696Medicaid
AL51595736OtherBCBS
AL009997275Medicaid
AL51595734OtherBCBS
AL009997255Medicaid
AL009997265Medicaid
AL135747Medicaid
AL51595735OtherBCBS
AL009911028Medicaid
AL51001496OtherBCBS OF AL
AL51595730OtherBCBS