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General NPI Number Information
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NPI Number | 1598761975
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Entity Type | Individual
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Provider Name | MICHAEL A SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 12122 TESSON FERRY RD STE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63128-1772
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Country | US
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Telephone | 314-842-6183
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Fax | 314-842-6184
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Provider Business Mailing Address
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Address Line | 12639 OLD TESSON RD SUITE 115
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2786
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Country | US
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Telephone | 314-849-0311
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Fax | 314-849-4423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 112235
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License Number State | MO
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