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General NPI Number Information
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NPI Number | 1477012458
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Entity Type | Organization
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Legal Business Name | WELLSMITH PLLC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1732 W HUBBARD ST STE 2A
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City | CHICAGO
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State | IL
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Zip | 60622-6271
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Country | US
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Telephone | 773-675-1400
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Fax | 773-598-6616
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Provider Business Mailing Address
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Address Line | 1644 N PAULINA ST
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City | CHICAGO
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State | IL
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Zip | 60622-1404
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Country | US
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Telephone | 773-307-8174
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CASEY SMITH KELLEY
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Credential | MD
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Telephone | 773-675-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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