Individual
EMANUEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2241 ELLSWORTH ST, GARY, IN 46404-3320
(219) 588-8548
Mailing address
2241 ELLSWORTH ST, GARY, IN 46404-3320
(219) 588-8548
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
07/10/2018
Last updated
07/10/2018
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