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NPI Code Detail

MEDICARE: DR. CARLOS FREDERICK SMITH DPM

MEDICARE: DR. CARLOS FREDERICK SMITH DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist016004833IL
2213E00000XPodiatrist016004833IL

General Provider Information

NPI Number : 1033190079
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLOS FREDERICK SMITH DPM
Provider Business Mailing Address
First Line : 711 W NORTH AVE
Second Line : STE 210
City : CHICAGO
State : IL
Zip : 60610-1174
Country : US
Telephone Number : 312-642-3440
Fax Number : 312-642-4319
Provider Business Practice Location Address
First Line : 1301 E 47TH ST BLDG 2
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4507
Country : US
Telephone Number : 773-924-7765
Fax Number : 773-924-8468
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 06/21/2021

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