Individual
DR. ALICE M MITCHELL-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, RM DG412, INDIANAPOLIS, IN 46202-1239
(317) 963-1400
(317) 962-4950
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01070795A
IN
207P00000X
Emergency Medicine Physician
200400555
NC
2085U0001X
Diagnostic Ultrasound Physician
200400555
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1372H
NCBCBS
NC
05
—
201061700
—
IN
05
—
891372H
—
NC
05
—
N0055D
—
SC
Enumeration date
07/26/2006
Last updated
03/02/2015
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