Basic Information
| Provider Information | |||||||||
| NPI: | 1609872860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | LAMONT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18667 | ||||||||
| Address2: | |||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410180667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595723617 | ||||||||
| FaxNumber: | 8595722326 | ||||||||
| Practice Location | |||||||||
| Address1: | 8251 PINE RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8337817611 | ||||||||
| FaxNumber: | 8595722326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 19102 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35050367 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | 35050367 | OH | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 0563091 | 05 | OH | MEDICAID | 100328930 | 05 | IN | MEDICAID | 64191026 | 05 | KY | MEDICAID |