Healthcare Provider Details

I. General information

NPI: 1740240076
Provider Name (Legal Business Name): MICHAEL J SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W HAMILTON AVE
EAU CLAIRE WI
54701-6937
US

IV. Provider business mailing address

2403 FOLSOM ST
EAU CLAIRE WI
54703-2435
US

V. Phone/Fax

Practice location:
  • Phone: 715-830-9990
  • Fax: 715-830-9995
Mailing address:
  • Phone: 715-552-9784
  • Fax: 715-835-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33571
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33571
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: