Healthcare Provider Details

I. General information

NPI: 1841392883
Provider Name (Legal Business Name): KATHLEEN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 25TH ST STE C
COLUMBUS IN
47201-3240
US

IV. Provider business mailing address

4832 TIMBER RIDGE DR
COLUMBUS IN
47201-8810
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8426
  • Fax: 812-378-7777
Mailing address:
  • Phone: 123-422-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057282
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: