Provider Demographics
NPI:1417211756
Name:SMART, NIKOL LEI (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOL
Middle Name:LEI
Last Name:SMART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKOL
Other - Middle Name:LEI
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:636-344-1073
Mailing Address - Fax:636-344-1075
Practice Address - Street 1:20 PROGRESS POINT PKWY
Practice Address - Street 2:STE 206
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2206
Practice Address - Country:US
Practice Address - Phone:636-344-1073
Practice Address - Fax:636-344-1075
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016729207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology