Provider Demographics
NPI:1487619011
Name:SMITH, MICHEAL ROBERT (MD)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 MALSBARY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5644
Mailing Address - Country:US
Mailing Address - Phone:513-366-4488
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:8000 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2163
Practice Address - Country:US
Practice Address - Phone:513-232-0120
Practice Address - Fax:513-232-8483
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031906207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2520418OtherUNITED
OH0326392Medicaid
000000238179OtherMIDDLETOWN
KY64734700Medicaid
OH0326392Medicaid
D31920Medicare UPIN
2520418OtherUNITED