Individual
C RICHARD SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2150 GETTLER ST STE 400, DYER, IN 46311-2385
(219) 865-0893
(219) 865-3599
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
02000747A
IN
207RI0011X
Interventional Cardiology Physician
036-055627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036055627
—
IL
05
—
100338620A
—
IN
Enumeration date
12/12/2005
Last updated
03/17/2018
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