Individual
LISA HELENE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
813 W 2ND ST, BLOOMINGTON, IN 47403-2212
(812) 353-3470
Mailing address
1 JARRETT WHITE RD, TRIPLER AMC, HI 96859-5001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01063998A
IN
2084E0001X
Epilepsy Physician
01063998A
IN
2084N0400X
Neurology Physician
1063998A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
01063998A
IN
2084N0600X
Clinical Neurophysiology Physician
01063998A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000628410
ANTHEM PTAN
IN
01
—
1102246535
ANTHEM PTAN
IN
05
—
200889720
—
IN
01
—
262210G
MEDICARE PTAN
IN
Enumeration date
11/22/2005
Last updated
01/22/2026
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