Provider Demographics
NPI:1518993567
Name:SMELSER, MICHAEL HARDING (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HARDING
Last Name:SMELSER
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 1:345 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-4078
Mailing Address - Country:US
Mailing Address - Phone:731-632-3383
Mailing Address - Fax:731-632-3762
Practice Address - Street 1:345 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-4078
Practice Address - Country:US
Practice Address - Phone:731-632-3383
Practice Address - Fax:731-632-3762
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9098207R00000X
MS13327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717101Medicaid
TN12047Medicaid
TN3164828Medicare ID - Type UnspecifiedSELMER
TN12047Medicaid
TN3164829Medicare ID - Type UnspecifiedHENDERSON
TN3717101Medicaid
TN3842944Medicare ID - Type UnspecifiedADAMSVILLE