Provider Demographics
NPI:1467691766
Name:SMITH, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
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 1:2134 14TH AVENUE CIR NW STE D
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7358
Mailing Address - Country:US
Mailing Address - Phone:828-580-1236
Mailing Address - Fax:828-580-1992
Practice Address - Street 1:2134 14TH AVENUE CIR NW STE D
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-7358
Practice Address - Country:US
Practice Address - Phone:828-580-1236
Practice Address - Fax:828-580-1992
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1025492085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007267500Medicaid
FL007267500Medicaid