MEDICARE: DR. JAMIE SMITH PENK 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
1	208000000X	Pediatrics Physician	238558	NY
2	2080P0203X	Pediatric Critical Care Medicine Physician	W2346	TX
3	208000000X	Pediatrics Physician	036.117924	IL

General Provider Information

NPI Number	:	1942243555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE SMITH PENK MD

Provider Business Mailing Address
First Line	:	4900 MUELLER BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3051
Country	:	US
Telephone Number	:	773-577-3782
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 MUELLER BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3051
Country	:	US
Telephone Number	:	773-577-3782
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/12/2026

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