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General NPI Number Information
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NPI Number | 1609063155
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Entity Type | Organization
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Legal Business Name | CARLOS F SMITH DPM PC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 711 W NORTH AVE STE 210
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City | CHICAGO
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State | IL
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Zip | 60610-1042
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Country | US
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Telephone | 312-642-3440
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Fax | 312-642-4319
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Provider Business Mailing Address
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Address Line | 711 W NORTH AVE STE 210
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City | CHICAGO
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State | IL
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Zip | 60610-1042
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Country | US
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Telephone | 312-642-3440
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Fax | 312-642-4319
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLOS FREDERICK SMITH
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Credential | DPM
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Telephone | 312-642-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016004833
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License Number State | IL
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