Provider Demographics
NPI:1689678021
Name:SMITH, LOWELL D (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NAVARRE PL
Mailing Address - Street 2:STE 5550
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1169
Mailing Address - Country:US
Mailing Address - Phone:574-234-5123
Mailing Address - Fax:574-237-1341
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:STE 240
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9151
Practice Address - Country:US
Practice Address - Phone:269-408-1852
Practice Address - Fax:269-408-1853
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041350A207RH0003X
MI4301025790207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A75954Medicare UPIN
IN216950AMedicare PIN
MIN43780003Medicare PIN