Healthcare Provider Details

I. General information

NPI: 1841289972
Provider Name (Legal Business Name): STEVEN D SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W WASHINGTON ST STE 155
INDIANAPOLIS IN
46204-3496
US

IV. Provider business mailing address

9986 N WIND RIVER RUN
MCCORDSVILLE IN
46055-9453
US

V. Phone/Fax

Practice location:
  • Phone: 317-559-2185
  • Fax:
Mailing address:
  • Phone: 740-501-0196
  • Fax: 351-222-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01068922A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35052435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: