MEDICARE: SUZANNE B. SMITH-ELEKES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	02001612A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000491337	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P00390071	OTHER		RAILROAD

General Provider Information

NPI Number	:	1447242599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE B. SMITH-ELEKES DO

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-479-3514
Fax Number	:	260-479-3520

Provider Business Practice Location Address
First Line	:	7900 W JEFFERSON BLVD STE 304
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4128
Country	:	US
Telephone Number	:	260-458-3600
Fax Number	:	260-458-3601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	09/30/2020

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Directions to “ SUZANNE B. SMITH-ELEKES DO” Practice Location

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