MEDICARE: TRAVIS R SMITH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085002991	IL
2	363AS0400X	Surgical Physician Assistant	085002991	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209118	OTHER	IL	MEDICARE PTAN LOCALITY 15
2	209119	OTHER	IL	MEDICARE PTAN LOCALITY 16

General Provider Information

NPI Number	:	1619176021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS R SMITH PA-C

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:	847-390-4757

Provider Business Practice Location Address
First Line	:	4847 HOFFMAN BLVD
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60192-3722
Country	:	US
Telephone Number	:	847-685-4646
Fax Number	:	847-685-4631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	03/05/2026

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Directions to “ TRAVIS R SMITH PA-C” Practice Location

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