MEDICARE: DR. RUDYARD URIAH SMITH M.D.

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	202250	IN
2	207R00000X	Internal Medicine Physician	036053241	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	21627739	OTHER	IL	BLUE CROSS ID
3	036053241	OTHER	IL	LICENSE NUMBER
4	01037640A	OTHER	IN	LICENSE NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295784031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDYARD URIAH SMITH M.D.

Provider Business Mailing Address
First Line	:	539 SAINT ANDREWS DR
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2951
Country	:	US
Telephone Number	:	219-937-9653
Fax Number	:	219-937-1486

Provider Business Practice Location Address
First Line	:	1514 E 87TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-6525
Country	:	US
Telephone Number	:	773-978-0757
Fax Number	:	773-978-0705

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/06/2021

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Directions to “ DR. RUDYARD URIAH SMITH M.D.” Practice Location

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