MEDICARE: SMETZALEZ MEDICAL MANAGEMENT, INC.

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

General Provider Information

NPI Number	:	1932194826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMETZALEZ MEDICAL MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 840638
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33084-2638
Country	:	US
Telephone Number	:	954-983-1969
Fax Number	:	954-983-1980

Provider Business Practice Location Address
First Line	:	2295 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3611
Country	:	US
Telephone Number	:	954-983-1969
Fax Number	:	954-983-1980

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL A SMETS
Credential	:	M.D.
Telephone Number	:	954-893-7654

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	04/28/2009

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