Healthcare Provider Details

I. General information

NPI: 1518943729
Provider Name (Legal Business Name): JOANNE BACON SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MEDICAL DR STE 102
CARMEL IN
46032-3078
US

IV. Provider business mailing address

310 MEDICAL DR STE 102
CARMEL IN
46032-3078
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01050969A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: