Individual
JONATHAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5700
(317) 621-7896
Mailing address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11024411A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300115608
—
IN
Enumeration date
03/28/2025
Last updated
07/28/2025
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