Individual
DR. SMITHA MARY JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.,
Contact information
Practice address
1201 NW 16TH ST, MIAMI, FL 33125-1624
(305) 575-7000
Mailing address
1201 NW 16TH ST, MIAMI, FL 33125-1624
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
35.120217
OH
2085N0904X
Nuclear Radiology Physician
35.120217
OH
2085R0202X
Diagnostic Radiology Physician
Primary
35.120217
OH
2085R0202X
Diagnostic Radiology Physician
ME117157
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073362
—
OH
01
—
204881619259
CARESOURCE
OH
01
—
35.120217
LICENSE
OH
01
—
710865
WELLCARE
OH
Enumeration date
06/28/2010
Last updated
10/19/2020
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