MEDICARE: DALE M SMITH D.P.M.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	213E00000X	Podiatrist	016002624	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831197052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE M SMITH D.P.M.

Provider Business Mailing Address
First Line	:	5405 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2349
Country	:	US
Telephone Number	:	708-425-7476
Fax Number	:	708-425-4223

Provider Business Practice Location Address
First Line	:	1030 N STATE ST APT 49B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-2839
Country	:	US
Telephone Number	:	312-810-7476
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/04/2025

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