Healthcare Provider Details

I. General information

NPI: 1699942656
Provider Name (Legal Business Name): MICHAEL ROBERT SMITH JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CROSSROADS DR STE 15
OWINGS MILLS MD
21117-5479
US

IV. Provider business mailing address

4321 TRAVANCORE CT
RANDALLSTOWN MD
21133-1315
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-4343
  • Fax:
Mailing address:
  • Phone: 443-386-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01466
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: