Healthcare Provider Details

I. General information

NPI: 1740129121
Provider Name (Legal Business Name): JELANI SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

IV. Provider business mailing address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-5700
  • Fax: 708-422-8225
Mailing address:
  • Phone: 708-422-5700
  • Fax: 708-422-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: