Healthcare Provider Details

I. General information

NPI: 1841307543
Provider Name (Legal Business Name): JOYCE MARIE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 S ELLIS AVE
CHICAGO IL
60653-3625
US

IV. Provider business mailing address

3223W 63RD ST
CHICAGO IL
60629-3333
US

V. Phone/Fax

Practice location:
  • Phone: 773-536-0470
  • Fax: 773-536-0472
Mailing address:
  • Phone: 773-768-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-063911
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: