Healthcare Provider Details

I. General information

NPI: 1811950462
Provider Name (Legal Business Name): WILLIAM LEE SMITS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 ENGLE ROAD
FORT WAYNE IN
46804-2222
US

IV. Provider business mailing address

7222 ENGLE ROAD
FORT WAYNE IN
46804-2222
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-5005
  • Fax: 260-432-6003
Mailing address:
  • Phone: 260-432-5005
  • Fax: 260-432-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01044372A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number01044372A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number01044372A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: