Healthcare Provider Details

I. General information

NPI: 1588153845
Provider Name (Legal Business Name): ANDREW MICHAEL SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date: 12/13/2018
Reactivation Date: 12/19/2018

III. Provider practice location address

740 S LIMESTONE D200
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

462 GRIDER STREET 206 DK MILLER BUILDING, ERIE COUNTY
BUFFALO NY
14215
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9555
  • Fax: 859-257-0662
Mailing address:
  • Phone: 716-898-4226
  • Fax: 716-898-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number55057
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number55057
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: