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NPI Code Detail

MEDICARE: MICHELLE LESLIE SMITH MD

MEDICARE: MICHELLE LESLIE SMITH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianPT21518ND
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianA187996CA
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1376047936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LESLIE SMITH MD
Provider Business Mailing Address
First Line : PO BOX 860939
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55486
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4440 S. WASHINGTON ST
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201
Country : US
Telephone Number : 701-780-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 12/30/2025

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