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General NPI Number Information
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NPI Number | 1427242452
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Entity Type | Individual
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Provider Name | SMITA KETAN JOBANPUTRA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 396 REMINGTON BLVD STE 250
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4303
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Country | US
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Telephone | 630-759-2966
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Fax | 630-759-9776
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Provider Business Mailing Address
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Address Line | 396 REMINGTON BLVD STE 250
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4303
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Country | US
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Telephone | 630-759-2966
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Fax | 630-759-9776
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-117162
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License Number State | IL
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