=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154371672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EYTAN SZMUILOWICZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 E SUPERIOR ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-926-0001
-----------------------------------------------------
Fax | 312-926-4588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E ONTARIO ST STE 700
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-926-0008
-----------------------------------------------------
Fax | 312-926-4588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 036121156
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------