Basic Information
| Provider Information | |||||||||
| NPI: | 1447245758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13151 MAGISTERIAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871236 | ||||||||
| FaxNumber: | 5025870126 | ||||||||
| Practice Location | |||||||||
| Address1: | 13151 MAGISTERIAL DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871236 | ||||||||
| FaxNumber: | 5025870126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 25914 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.