Provider Demographics
NPI:1346242617
Name:SMITH, DIRK M (MD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8200 W CENTRAL AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-9503
Mailing Address - Country:US
Mailing Address - Phone:316-721-4544
Mailing Address - Fax:316-721-8307
Practice Address - Street 1:8200 W CENTRAL AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-9503
Practice Address - Country:US
Practice Address - Phone:316-721-4544
Practice Address - Fax:316-721-8307
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29410207Q00000X
IN01071473A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100040030BMedicaid
KS100040030BMedicaid
IN258190001Medicare PIN
KS100040030BMedicaid
IN201085970Medicaid