Provider Demographics
NPI:1629255377
Name:MAXEY-SMARTT, MECCA K (MD)
Entity Type:Individual
Prefix:
First Name:MECCA
Middle Name:K
Last Name:MAXEY-SMARTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MECCA
Other - Middle Name:K
Other - Last Name:MAXEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9757 WESTPOINT DR STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3329
Practice Address - Country:US
Practice Address - Phone:971-962-8893
Practice Address - Fax:317-944-0470
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119520207Q00000X
IN01063955A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266430767OtherMEDICARE
IN300023480Medicaid