Provider Demographics
NPI:1669811253
Name:PORTA, LINDSEY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ELIZABETH
Last Name:PORTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-935-8802
Mailing Address - Fax:
Practice Address - Street 1:11051 STATE ROAD 101
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-8836
Practice Address - Country:US
Practice Address - Phone:765-547-4231
Practice Address - Fax:765-547-1414
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092090A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine