Individual
KEVIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1225 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6312
(219) 861-8161
(219) 873-9504
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000208A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000369959
ANTHEM
IN
Enumeration date
01/27/2006
Last updated
03/22/2021
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