Healthcare Provider Details

I. General information

NPI: 1346533700
Provider Name (Legal Business Name): KATHLEEN SMITH MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 10TH ST
COLUMBUS IN
47201-6603
US

IV. Provider business mailing address

PO BOX 1133
FRANKLIN IN
46131-5233
US

V. Phone/Fax

Practice location:
  • Phone: 317-346-5412
  • Fax: 317-736-3548
Mailing address:
  • Phone: 317-346-5412
  • Fax: 317-736-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057282A
License Number StateIN

VIII. Authorized Official

Name: MRS. DONNA GABBARD
Title or Position: MANAGER
Credential:
Phone: 317-346-5412