Individual
DR. JAYANTHI RACHAKONDA SMUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
415 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 533-1234
(574) 533-1234
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 533-1234
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036098627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098627
—
IL
01
—
093984
HEALTH ALLIANCE
IL
01
—
540733
HEALTHLINK
IL
01
—
P00159341
RAILROAD MEDICARE
IL
Enumeration date
08/31/2006
Last updated
03/03/2016
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