MEDICARE: MICHAEL ANTHONY SMITH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1336837467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANTHONY SMITH

Provider Business Mailing Address
First Line	:	4499 PEARSE AVE
Second Line	:
City	:	NEWBURGH HTS
State	:	OH
Zip	:	44105-3239
Country	:	US
Telephone Number	:	216-338-1550
Fax Number	:

Provider Business Practice Location Address
First Line	:	4499 PEARSE AVE
Second Line	:
City	:	NEWBURGH HTS
State	:	OH
Zip	:	44105-3239
Country	:	US
Telephone Number	:	216-338-1550
Fax Number	:

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

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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Directions to “ MICHAEL ANTHONY SMITH ” Practice Location

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