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General NPI Number Information
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NPI Number | 1588607345
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Entity Type | Organization
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Legal Business Name | RUDYARD SMITH MD AND ASSOCIATES SC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 1514 E 87TH ST
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City | CHICAGO
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State | IL
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Zip | 60619-6525
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Country | US
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Telephone | 773-978-0757
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Fax | 773-978-0705
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Provider Business Mailing Address
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Address Line | 3510 W 79TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-1430
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Country | US
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Telephone | 773-978-0757
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Fax | 773-978-0705
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUDYARD U SMITH
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Credential | M.D.,
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Telephone | 773-978-0757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036053241
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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