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NPI Code Detail

MEDICARE: TANISHA LEANNA SMITH DPM

MEDICARE: TANISHA LEANNA SMITH DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213EP1101XPrimary Podiatric Medicine Podiatrist07001108AIN
2213ES0103XFoot & Ankle Surgery PodiatristPO 3402FL

General Provider Information

NPI Number : 1316264187
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANISHA LEANNA SMITH DPM
Provider Business Mailing Address
First Line : 30 W MONROE ST STE 1200
Second Line :
City : CHICAGO
State : IL
Zip : 60603-2420
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Provider Business Practice Location Address
First Line : 5926 CRAWFORDSVILLE RD UNIT B
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46224-3722
Country : US
Telephone Number : 317-653-2730
Fax Number : 317-321-1935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2010
Last Update Date : 06/23/2020

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Directions to “ TANISHA LEANNA SMITH DPM” Practice Location

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