MEDICARE: DR. KENNETH R SMITH M.D.

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
1	207W00000X	Ophthalmology Physician	34564	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386619021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH R SMITH M.D.

Provider Business Mailing Address
First Line	:	9700 PARK PLAZA AVE UNIT 103
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2286
Country	:	US
Telephone Number	:	502-429-3937
Fax Number	:	502-429-3996

Provider Business Practice Location Address
First Line	:	9700 PARK PLAZA AVE UNIT 103
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2286
Country	:	US
Telephone Number	:	502-429-3937
Fax Number	:	502-429-3996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	09/25/2008

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