MEDICARE: DR. MICHAEL L. SMITH M.D

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	207R00000X	Internal Medicine Physician	17033	AZ

General Provider Information

NPI Number	:	1760782973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L. SMITH M.D

Provider Business Mailing Address
First Line	:	1684 E BOSTON ST STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6220
Country	:	US
Telephone Number	:	480-899-4420
Fax Number	:	480-219-3214

Provider Business Practice Location Address
First Line	:	1684 E BOSTON ST STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6220
Country	:	US
Telephone Number	:	480-899-4420
Fax Number	:	480-219-3214

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

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	10/22/2010

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