Provider Demographics
NPI:1629085816
Name:RAIKER, SMITA K (MD)
Entity Type:Individual
Prefix:MRS
First Name:SMITA
Middle Name:K
Last Name:RAIKER
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 1:9038 COLUMBIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-5758
Mailing Address - Fax:219-836-5774
Practice Address - Street 1:9038 COLUMBIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-5758
Practice Address - Fax:219-836-5774
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047569207Q00000X
IL036100077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200250690Medicaid
IN000000485470OtherANTHEM
IN7017026OtherAETNA
INP00349431OtherRAILROAD MEDICARE
IL90001294OtherBC/BS ILLINOIS
G98558Medicare UPIN
IN237870AMedicare PIN