Healthcare Provider Details

I. General information

NPI: 1114020567
Provider Name (Legal Business Name): DONALD IAN SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188B N MERIDIAN ST STE 350B
CARMEL IN
46032-4900
US

IV. Provider business mailing address

12188B N MERIDIAN ST STE 350B
CARMEL IN
46032-4900
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-1841
  • Fax:
Mailing address:
  • Phone: 317-582-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036110127
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number01051881A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01051881
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01051881A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: