Healthcare Provider Details

I. General information

NPI: 1659717841
Provider Name (Legal Business Name): ABIGAIL LINN SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL LINN STRUCK-MARCELL

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 N PULASKI RD
CHICAGO IL
60639-5207
US

IV. Provider business mailing address

1431 N WESTERN AVE SUITE 401
CHICAGO IL
60622-1797
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-6868
  • Fax: 773-278-6922
Mailing address:
  • Phone: 312-633-5841
  • Fax: 312-491-5485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-138831
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: