Provider Demographics
NPI:1114954625
Name:SMITH, JANET LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22450207RC0000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000693033OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
IN100014390Medicaid
KY64224504Medicaid
IN100388540FMedicaid
KY2433847000OtherPASSPORT ADVANTAGE PIN
KY000057080SOtherHUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
KYP00893018OtherPASSPORT- CTS
KY000000044935OtherANTHEM PIN
KYP00893018OtherRAILROAD MEDICARE- CTS
IN100388540AMedicaid
KY1056156OtherPASSPORT PIN
KY1056156OtherPASSPORT PIN
KY000000693033OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY0558405Medicare PIN
KY0713002Medicare PIN
KY1271810Medicare PIN
KY000000044935OtherANTHEM PIN
KYP00893018OtherRAILROAD MEDICARE- CTS
IN100388540FMedicaid
KY060049845Medicare PIN