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NPI Code Detail

MEDICARE: DR. JODI L SMITH MD, PHD

MEDICARE: DR. JODI L SMITH MD, PHD
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
1207T00000XNeurological Surgery Physician01052779AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000640757OTHERINANTHEM BLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number : 1518960004
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JODI L SMITH MD, PHD
Provider Business Mailing Address
First Line : 13345 ILLINOIS ST
Second Line :
City : CARMEL
State : IN
Zip : 46032-3318
Country : US
Telephone Number : 317-396-1300
Fax Number : 317-352-3417
Provider Business Practice Location Address
First Line : 8402 HARCOURT RD STE 830
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2096
Country : US
Telephone Number : 317-396-1300
Fax Number : 317-396-1480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/26/2021

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