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General NPI Number Information
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NPI Number | 1144958489
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Entity Type | Individual
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Provider Name | MAURICE ERICK SMITH
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Gender | Male
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Dates
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Enumeration Date | 08/14/2022
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Last Update Date | 08/14/2022
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Provider Practice Location Address
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Address Line | 9839 SOUTH CHARLES STREET
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City | CHICAGO
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State | IL
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Zip | 60643-1205
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Country | US
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Telephone | 773-750-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 11005 S MICHIGAN AVE STE 427
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City | CHICAGO
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State | IL
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Zip | 60628-4308
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Country | US
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Telephone | 773-453-8883
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Fax |
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | S53054568009
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License Number State | IL
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