Provider Demographics
NPI:1114020567
Name:SMITH, DONALD IAN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:IAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12188B N MERIDIAN ST STE 350B
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4900
Mailing Address - Country:US
Mailing Address - Phone:317-582-1841
Mailing Address - Fax:
Practice Address - Street 1:12188B N MERIDIAN ST STE 350B
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4900
Practice Address - Country:US
Practice Address - Phone:317-582-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110127208D00000X
IN01051881A207ZC0500X, 207ZP0102X
IN01051881208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3170035OtherAETNA
KY7100037900Medicaid
H24078OtherMERCY HEALTH PLAN
IN1194840595OtherANTHEM-IN
MO1114020567OtherBCBS-MO
P00443719OtherRAILROAD MEDICARE
IN200086440Medicaid
IN173867OtherINDIANA COMPREHENSIVE
IN1194840595OtherANTHEM-IN
P00443719OtherRAILROAD MEDICARE
KY7100037900Medicaid