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General NPI Number Information
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NPI Number | 1831197052
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Entity Type | Individual
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Provider Name | DALE M SMITH D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1030 N STATE ST APT 49B
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City | CHICAGO
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State | IL
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Zip | 60610-2839
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Country | US
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Telephone | 312-810-7476
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Fax |
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Provider Business Mailing Address
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Address Line | 5405 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2349
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Country | US
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Telephone | 708-425-7476
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Fax | 708-425-4223
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016002624
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License Number State | IL
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