MEDICARE: DR. BRUCE WILLIAM SMIT D.P.M.

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	213ES0131X	Foot Surgery Podiatrist	16-2719	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60100822	OTHER	IL	BC BS

General Provider Information

NPI Number	:	1205831948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE WILLIAM SMIT D.P.M.

Provider Business Mailing Address
First Line	:	9875 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1930
Country	:	US
Telephone Number	:	815-469-3211
Fax Number	:	815-469-3808

Provider Business Practice Location Address
First Line	:	9875 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1930
Country	:	US
Telephone Number	:	815-469-3211
Fax Number	:	815-469-3808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	05/19/2022

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