Provider Demographics
NPI:1679688915
Name:KENNETH R SMITH MD PLLC
Entity Type:Organization
Organization Name:KENNETH R SMITH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-429-3937
Mailing Address - Street 1:9700 PARK PLAZA AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2286
Mailing Address - Country:US
Mailing Address - Phone:502-429-3937
Mailing Address - Fax:502-429-3996
Practice Address - Street 1:9700 PARK PLAZA AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2286
Practice Address - Country:US
Practice Address - Phone:502-429-3937
Practice Address - Fax:502-429-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDC1334OtherRAILROAD MEDICARE
KY7968Medicare PIN