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NPI Code Detail

MEDICARE: CLARISSA BETH SMITH MD

MEDICARE: CLARISSA BETH SMITH MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RC0200XCritical Care Medicine (Internal Medicine) Physician036164264IL

General Provider Information

NPI Number : 1467080325
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARISSA BETH SMITH MD
Provider Business Mailing Address
First Line : 180 HARVESTER DR STE 110
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-6686
Country : US
Telephone Number : 773-702-1150
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S. MARYLAND AVE
Second Line : M/C 6076
City : CHICAGO
State : IL
Zip : 60637-1443
Country : US
Telephone Number : 773-702-9660
Fax Number : 773-834-7068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 05/12/2023

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