Provider Demographics
NPI:1124012729
Name:SMITH, CLAUDET C (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDET
Middle Name:C
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 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:2030 CHURCHMAN AVE
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1044
Practice Address - Country:US
Practice Address - Phone:317-781-2100
Practice Address - Fax:317-781-2109
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067179A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7679166OtherAETNA
P00108820OtherRAILROAD MEDICARE
04529OtherPARAMOUNT
OH2205321Medicaid
OH000000322104OtherANTHEM BLUE CROSS
P00108820OtherRAILROAD MEDICARE
7679166OtherAETNA
OH2205321Medicaid
OH9284951Medicare PIN
OH4035974Medicare PIN