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General NPI Number Information
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NPI Number | 1033190079
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Entity Type | Individual
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Provider Name | CARLOS FREDERICK SMITH DPM
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 1301 E 47TH ST BLDG 2
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City | CHICAGO
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State | IL
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Zip | 60653-4507
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Country | US
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Telephone | 773-924-7765
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Fax | 773-924-8468
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Provider Business Mailing Address
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Address Line | 711 W NORTH AVE STE 210
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City | CHICAGO
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State | IL
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Zip | 60610-1174
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Country | US
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Telephone | 312-642-3440
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Fax | 312-642-4319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016004833
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004833
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License Number State | IL
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