Provider Demographics
NPI:1679650873
Name:SMITH, CAROL LOIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LOIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8600 W 110 STREET
Mailing Address - Street 2:SUITE 214
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1805
Mailing Address - Country:US
Mailing Address - Phone:913-339-9700
Mailing Address - Fax:913-339-6336
Practice Address - Street 1:8600 W 110 STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1805
Practice Address - Country:US
Practice Address - Phone:913-339-9700
Practice Address - Fax:913-339-6336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSKS04203642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11438033OtherBCBS
KS2050518601Medicaid
D88704Medicare UPIN
KS0006429Medicare PIN