Individual
MITCHELL W. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
965 EMERSON PKWY, SUITE B, GREENWOOD, IN 46143-6273
(317) 865-0055
(317) 865-0056
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
02004276A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201095070
—
IN
01
—
IN1125020
MEDICARE PTAN
IN
01
—
IN1127019
MEDICARE PTAN
IN
Enumeration date
03/29/2010
Last updated
10/30/2023
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