Healthcare Provider Details

I. General information

NPI: 1588607345
Provider Name (Legal Business Name): RUDYARD SMITH MD AND ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 E 87TH ST
CHICAGO IL
60619-6525
US

IV. Provider business mailing address

3510 W 79TH ST
CHICAGO IL
60652-1430
US

V. Phone/Fax

Practice location:
  • Phone: 773-978-0757
  • Fax: 773-978-0705
Mailing address:
  • Phone: 773-978-0757
  • Fax: 773-978-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036053241
License Number StateIL

VIII. Authorized Official

Name: RUDYARD U SMITH
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 773-978-0757