MEDICARE: MR.OAK

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
1	207R00000X	Internal Medicine Physician
2	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1164917720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR.OAK

Provider Business Mailing Address
First Line	:	1629 S PRAIRIE AVE UNIT 1108
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-5059
Country	:	US
Telephone Number	:	312-259-8555
Fax Number	:	773-978-0705

Provider Business Practice Location Address
First Line	:	3510 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1430
Country	:	US
Telephone Number	:	312-259-8555
Fax Number	:	773-978-0705

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. STEVEN SMITH
Credential	:	MD
Telephone Number	:	312-259-8555

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	06/26/2018

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Directions to “MR.OAK ” Practice Location

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