Provider Demographics
NPI:1902835374
Name:SMITH, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CELEBRATION BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5161
Mailing Address - Country:US
Mailing Address - Phone:407-599-9899
Mailing Address - Fax:305-946-1029
Practice Address - Street 1:40107 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5901
Practice Address - Country:US
Practice Address - Phone:863-419-0692
Practice Address - Fax:863-419-1695
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL31002085R0001X
IN01036913A2085R0001X
TXH56822085R0001X
WAMD602956422085R0001X
TN0215622085R0001X
FL1031762085R0001X
HIMD-98522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5104065OtherAETNA
FLP116158OtherFREEDOM HEALTH
FL1459LOtherBCBS FL
IN200259350Medicaid
FLP306917OtherOPTIMUM
FL10L838OtherHEALTHY KIDS THRU COMMUNITY HEALTH PARTNERS
FL6067119OtherCIGNA
FLP01174095OtherRAILROAD MCR
FLP513688Medicaid
FL003674000Medicaid
FL364004OtherAVMED
FLP513688Medicaid
IN149720CCMedicare PIN
FL10L838OtherHEALTHY KIDS THRU COMMUNITY HEALTH PARTNERS
FLP116158OtherFREEDOM HEALTH
FLP01174095OtherRAILROAD MCR
FLBU836ZMedicare PIN