MEDICARE: ALEXANDRA SMALL 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	125067107	IL
2	207RR0500X	Rheumatology Physician	207RR0500X	IL

General Provider Information

NPI Number	:	1356722292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA SMALL M.D.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 365
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3836
Country	:	US
Telephone Number	:	312-226-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 365
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3836
Country	:	US
Telephone Number	:	312-226-8228
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	11/10/2021

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