Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 07001108A | IN |
N | 213ES0103X | Foot & Ankle Surgery | PO 3402 | FL |
NPI | 1316264187 |
---|---|
Provider Name | Tanisha Leanna Smith |
First Address | Chicago, IL 60603-2420 |
Second Address | Indianapolis, IN 46224-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 23/06/2020 |