Healthcare Provider Details

I. General information

NPI: 1114982410
Provider Name (Legal Business Name): LINNEA L SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RING RD
ELIZABETHTOWN KY
42701-8968
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-2107
  • Fax: 270-769-9642
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32243
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: