Provider Demographics
NPI:1548460066
Name:SMITH, MICHAEL KEVIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEVIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50976
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-0976
Mailing Address - Country:US
Mailing Address - Phone:615-612-3541
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING PIKE STE 104
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-4900
Practice Address - Country:US
Practice Address - Phone:615-383-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4160071OtherBLUE CROSS BLUE SHIELD
TN5416194OtherAETNA
TN3158590OtherBCBS
TN110215825OtherRAILROAD MCARE
TNP00466145OtherRAILROAD MEDICARE
TNG24160Medicare UPIN
TN3158590OtherBCBS
TN3806001Medicare PIN