Individual
MARY OLUWATOYIN EBUEKU-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 338-6815
Mailing address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
121121
AK
207R00000X
Internal Medicine Physician
0101281553
VA
207R00000X
Internal Medicine Physician
11591A
WY
207R00000X
Internal Medicine Physician
121121
AK
207R00000X
Internal Medicine Physician
60750536
WA
207R00000X
Internal Medicine Physician
S4942
TX
207R00000X
Internal Medicine Physician
TL4365
WY
208000000X
Pediatrics Physician
Primary
01080536A
IN
208000000X
Pediatrics Physician
11591A
WY
208000000X
Pediatrics Physician
TL4365
WY
208M00000X
Hospitalist Physician
MD213533
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025385
—
IN
01
—
P02259015
RR MEDICARE
IN
Enumeration date
05/01/2013
Last updated
11/14/2024
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