Provider Demographics
NPI:1922012509
Name:SMITH, MIKEL DWAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKEL
Middle Name:DWAINE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:GILL HEART INSTITUTE 900 SOUTH LIMESTONE ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-323-3976
Mailing Address - Fax:859-257-6060
Practice Address - Street 1:GILL HEART INSTITUTE 800 ROSE ST
Practice Address - Street 2:G100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-323-0295
Practice Address - Fax:859-257-8699
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22018207R00000X, 207RG0100X, 207RI0008X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64220189Medicaid
C65395Medicare UPIN
KY00258192Medicare PIN