Healthcare Provider Details

I. General information

NPI: 1134677651
Provider Name (Legal Business Name): ROGER STEPHEN SMITH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E HURON ST SUITE 1-200
CHICAGO IL
60611-2909
US

IV. Provider business mailing address

420 E SUPERIOR ST STE 9-900
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number125084077
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number125084077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: