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Individual

DR. JAMES R SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11725 N ILLINOIS ST, STE 350, CARMEL, IN 46032-3008
(317) 688-5200
(317) 688-5215
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01059536
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000520163
ANTHEM - CMA
KY
01
000023028M
HUMANA - CMA
KY
01
087582
SIHO
KY
01
0998852
MEDICARE - KY
KY
01
196290VVV
MEDICARE - IN
IN
05
200847330
IN
01
2853693000
PASSPORT - ADVTG
KY
01
50015452
PASSPORT
KY
01
8153595
CIGNA - CMA
KY
01
9008078
AETNA - CMA
KY
01
P00612412
RR MCR- KY/CMA
KY
Enumeration date
10/20/2006
Last updated
02/27/2014
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