Individual
LYNETTE SMITH-CAILLOUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
285 W 12TH ST STE 106, PERU, IN 46970-1654
(765) 472-8041
(260) 479-2926
Mailing address
6920 POINTE INVERNESS WAY, FORT WAYNE, IN 46804-7938
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01070112A
IN
207R00000X
Internal Medicine Physician
036097814
IL
207RP1001X
Pulmonary Disease Physician
01070112A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200218630
—
IN
01
—
P01210504
RR MEDICARE PTAN
IN
01
—
P01227271
RR MEDICARE PTAN
IN
01
—
P01270958
RR MEDICARE
IN
Enumeration date
10/06/2006
Last updated
09/19/2022
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