Individual
MR. KENNETH A SMITH
Active
Individual
MR. KENNETH A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01022346
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006713
M PLAN
—
01
—
000000206530
ANTHEM
—
01
—
000000637485
ANTHEM
IN
05
—
100108770A
—
IN
01
—
1866
PHP
—
05
—
200092670
—
IN
01
—
4351567
AETNA
—
01
—
P00786840
R.R. MEDICARE
IN
Enumeration date
09/28/2006
Last updated
08/03/2012
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