MEDICARE: MICHAEL DAVID 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	2085R0202X	Diagnostic Radiology Physician	036078435	IL

General Provider Information

NPI Number	:	1386637148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID SMITH M.D.

Provider Business Mailing Address
First Line	:	600 N LAKE SHORE DR
Second Line	:	APT 3301
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	312-371-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N LAKE SHORE DR
Second Line	:	APT 3301
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	312-371-5200
Fax Number	:	312-371-5200

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	12/15/2017

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