Healthcare Provider Details

I. General information

NPI: 1316075559
Provider Name (Legal Business Name): KYLA NICHELLE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLA NICHELLE SMITH MD

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 W 127TH ST STE 130
PALOS HEIGHTS IL
60463-1579
US

IV. Provider business mailing address

7110 W 127TH ST STE 130
PALOS HEIGHTS IL
60463-1579
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-6300
  • Fax: 708-923-6303
Mailing address:
  • Phone: 708-923-6300
  • Fax: 708-923-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-128969
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036-128969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: