MEDICARE: RUDYARD SMITH MD AND ASSOCIATES SC

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	036053241	IL
2	261QM1300X	Multi-Specialty Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110233216	OTHER	IL	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1588607345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUDYARD SMITH MD AND ASSOCIATES SC

Provider Business Mailing Address
First Line	:	3510 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1430
Country	:	US
Telephone Number	:	773-978-0757
Fax Number	:	773-978-0705

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	:	PRESIDENT
Name	:	RUDYARD U SMITH
Credential	:	M.D.,
Telephone Number	:	773-978-0757

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/31/2025

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