Provider Demographics
NPI:1457314049
Name:SMIKLE, YVONNE MAY (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MAY
Last Name:SMIKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4543
Mailing Address - Country:US
Mailing Address - Phone:781-286-1313
Mailing Address - Fax:781-286-1098
Practice Address - Street 1:425 REVERE ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4543
Practice Address - Country:US
Practice Address - Phone:781-286-1313
Practice Address - Fax:781-286-1098
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2022061Medicaid
H95834Medicare UPIN
MA2022061Medicaid