MEDICARE: DR. MICHAEL WARREN SMITH MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200300709	NC

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1003830530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WARREN SMITH MD

Provider Business Mailing Address
First Line	:	6115 PARK SOUTH DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3281
Country	:	US
Telephone Number	:	704-554-8787
Fax Number	:	704-554-8774

Provider Business Practice Location Address
First Line	:	6115 PARK SOUTH DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3281
Country	:	US
Telephone Number	:	704-554-8787
Fax Number	:	704-554-8774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	06/27/2023

6115 PARK SOUTH DR STE 100
CHARLOTTE, NC
28210-3281

Practice Phone: 704-554-8787
Practice Fax:

6115 PARK SOUTH DR STE 100
CHARLOTTE, NC
28210-3281