Healthcare Provider Details

I. General information

NPI: 1144911306
Provider Name (Legal Business Name): MEGHAN JOY SMITH M.D. FRCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date: 12/21/2023
Reactivation Date: 01/10/2024

III. Provider practice location address

820 SOUTH WOOD STREET UI HEALTH, GRADUATE MEDICAL EDUC SUITE 100 MC 675
CHICAGO IL
60612
US

IV. Provider business mailing address

901 S ASHLAND AVE APT 908
CHICAGO IL
60607-4090
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2933
  • Fax:
Mailing address:
  • Phone: 773-397-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.081827
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number125081827
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: