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General NPI Number Information
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NPI Number | 1093070211
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Entity Type | Organization
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Legal Business Name | PAMELA E SMITH MD MPH CHES SC
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 2701 W 68TH ST
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City | CHICAGO
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State | IL
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Zip | 60629-1813
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Country | US
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Telephone | 773-884-7920
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Fax | 773-884-8065
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Provider Business Mailing Address
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Address Line | 1950 S AVERS AVE
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City | CHICAGO
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State | IL
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Zip | 60623-2450
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Country | US
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Telephone | 773-490-8842
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Fax | 773-277-0027
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA ELEASHIA SMITH
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Credential | MD
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Telephone | 773-490-8842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036062316
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License Number State | IL
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