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NPI Code Detail

MEDICARE: DYLAN LOUISE SMITH PA-C

MEDICARE: DYLAN LOUISE SMITH PA-C
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
1363A00000XPhysician AssistantPA.0008639CO

General Provider Information

NPI Number : 1598502163
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN LOUISE SMITH PA-C
Provider Business Mailing Address
First Line : 4600 SUNSET AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46208-3443
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4600 SUNSET AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46208-3443
Country : US
Telephone Number : 317-940-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2024
Last Update Date : 07/11/2024

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Directions to “ DYLAN LOUISE SMITH PA-C” Practice Location

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