Provider Demographics
NPI:1336837467
Name:SMITH, MICHAEL ANTHONY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 PEARSE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3239
Mailing Address - Country:US
Mailing Address - Phone:216-338-1550
Mailing Address - Fax:
Practice Address - Street 1:4499 PEARSE AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH HTS
Practice Address - State:OH
Practice Address - Zip Code:44105-3239
Practice Address - Country:US
Practice Address - Phone:216-338-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist