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General NPI Number Information
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NPI Number | 1316978174
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Entity Type | Individual
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Provider Name | BLAKE ALLEN SMITH D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 225 W WASHINGTON ST STE 1500
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City | CHICAGO
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State | IL
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Zip | 60606-3485
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Country | US
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Telephone | 847-504-5000
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Fax | 847-504-5015
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Provider Business Mailing Address
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Address Line | 225 W WASHINGTON ST STE 1500
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City | CHICAGO
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State | IL
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Zip | 60606-3485
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Country | US
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Telephone | 847-504-5000
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Fax | 847-504-5015
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004391
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License Number State | IL
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