Provider Demographics
NPI:1811950462
Name:SMITS, WILLIAM LEE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEE
Last Name:SMITS
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 1:7222 ENGLE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2222
Mailing Address - Country:US
Mailing Address - Phone:260-432-5005
Mailing Address - Fax:260-432-6003
Practice Address - Street 1:7222 ENGLE ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2222
Practice Address - Country:US
Practice Address - Phone:260-432-5005
Practice Address - Fax:260-432-6003
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044372A207K00000X, 2080P0201X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
352007446101OtherCARESOURCE
030003428OtherRAILROAD MEDICARE
5470020OtherAETNA
000000005310OtherM-PLAN
000000092049OtherANTHEM BCBS
10786190OtherCAQH
IN200062640Medicaid
IN237770AMedicare UPIN
F47840Medicare UPIN
924430Medicare ID - Type Unspecified