Provider Demographics
NPI:1659366250
Name:SMITH, MELISSA L (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 NW MURRAY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1204
Mailing Address - Country:US
Mailing Address - Phone:816-524-2626
Mailing Address - Fax:816-524-0173
Practice Address - Street 1:600 NW MURRAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1204
Practice Address - Country:US
Practice Address - Phone:816-524-2626
Practice Address - Fax:816-524-0173
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMD 108908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100453570AMedicaid
MO208935411Medicaid
MOG67571Medicare UPIN
KS100453570AMedicaid