MEDICARE: ELBERT B SMITH MDSC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1528364239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELBERT B SMITH MDSC

Provider Business Mailing Address
First Line	:	8012 S CRANDON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8015 S LUELLA AVE
Second Line	:	STE 207
City	:	CHICAGO
State	:	IL
Zip	:	60617-1199
Country	:	US
Telephone Number	:	773-221-4708
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ELBERT B SMITH
Credential	:	MD
Telephone Number	:	773-221-4708

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/28/2011

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