Healthcare Provider Details

I. General information

NPI: 1407975006
Provider Name (Legal Business Name): OTTO MITCHELL SMEYKAL HSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MACARTHUR CSWY
MIAMI BEACH FL
33139-5101
US

IV. Provider business mailing address

5402 DEER RUN DR
FORT PIERCE FL
34951-3346
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-4535
  • Fax:
Mailing address:
  • Phone: 772-519-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: