Healthcare Provider Details

I. General information

NPI: 1952835183
Provider Name (Legal Business Name): DAVID S SMITH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 W BETHEL AVE STE A
MUNCIE IN
47304-8513
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-751-5330
  • Fax: 317-222-2485
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001348A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: