Basic Information
| Provider Information | |||||||||
| NPI: | 1932194826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMETZALEZ MEDICAL MANAGEMENT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840638 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330842638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549831969 | ||||||||
| FaxNumber: | 9549831980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2295 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330243611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549831969 | ||||||||
| FaxNumber: | 9549831980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | SMETS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9548937654 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.