Provider Demographics
NPI:1437344058
Name:SMITH, MICHAEL TYLER (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TYLER
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271647
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ANESTHESIOLOGY N2198 UNC HOSPITALS
Practice Address - Street 2:CB #7010
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7010
Practice Address - Country:US
Practice Address - Phone:919-966-5136
Practice Address - Fax:984-974-4873
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC188833367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052957Medicaid
NC8052957Medicaid