Provider Demographics
NPI:1902975105
Name:SMITH, MICHAEL E (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:3165 MCCRORY PL
Mailing Address - Street 2:STE 174
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3727
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:2111 GLENWOOD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-647-1550
Practice Address - Fax:407-647-1561
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2033213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2580012OtherTAX ID
FL340400500Medicaid
FL65104VMedicare PIN
U09464Medicare UPIN