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General NPI Number Information
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NPI Number | 1679861371
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Entity Type | Organization
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Legal Business Name | JAMIERE Y SMITH MD SC
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 9951 SOUTH HALSTED STREET
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City | CHICAGO
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State | IL
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Zip | 60628-1035
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Country | US
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Telephone | 773-779-8285
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Fax | 773-779-8240
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Provider Business Mailing Address
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Address Line | 5312 S INGLESIDE AVE
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City | CHICAGO
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State | IL
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Zip | 60615-4310
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Country | US
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Telephone | 773-779-8285
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Fax | 773-324-2355
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Authorized Official
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Title or Position | OWNER
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Name | JAMIERE YOLANDE SMITH
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Credential | M.D.
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Telephone | 773-779-8285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036087325
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License Number State | IL
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