Provider Demographics
NPI:1518960004
Name:SMITH, JODI L (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13345 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3318
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-352-3417
Practice Address - Street 1:8402 HARCOURT RD STE 830
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2096
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-396-1480
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052779A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000640757OtherANTHEM BLUE CROSS AND BLUE SHIELD
IN200266970Medicare ID - Type Unspecified
IN061570VVVVMedicare PIN
IN0000640757OtherANTHEM BLUE CROSS AND BLUE SHIELD