Provider Demographics
NPI:1477517415
Name:SMITH, MICHAEL K (MF)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:MF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 SE CARY PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6130
Mailing Address - Country:US
Mailing Address - Phone:919-859-9991
Mailing Address - Fax:
Practice Address - Street 1:940 SE CARY PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6130
Practice Address - Country:US
Practice Address - Phone:919-859-9991
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28089208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8978009Medicaid
NC8978009Medicaid