Individual
SMARI THORDARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1007 LINCOLNWAY, LAPORTE, IN 46350-2301
(219) 326-2305
(219) 326-2605
Mailing address
1007 LINCOLNWAY, LAPORTE, IN 46350-2301
(219) 326-2305
(219) 326-2605
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01039747
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3213335
MEDICAID
MI
Enumeration date
07/13/2006
Last updated
07/08/2007
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