Healthcare Provider Details

I. General information

NPI: 1821060039
Provider Name (Legal Business Name): PAMELA E SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA E SMITH MD MPH CHES SC

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S AVERS AVE
CHICAGO IL
60623-2450
US

IV. Provider business mailing address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

V. Phone/Fax

Practice location:
  • Phone: 773-490-8842
  • Fax: 773-277-0027
Mailing address:
  • Phone: 773-490-8842
  • Fax: 773-277-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036062316
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036062316
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036062316
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036062316
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10883
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: