Healthcare Provider Details

I. General information

NPI: 1942903679
Provider Name (Legal Business Name): KATELYN SMILEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10767 ILLINOIS ST STE 1300
CARMEL IN
46032-8972
US

IV. Provider business mailing address

PO BOX 781076 STE G525
DETROIT MI
48278-1008
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-2298
  • Fax: 317-528-2779
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02009176A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: