MEDICARE: GREGORY 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
1	207Q00000X	Family Medicine Physician	036-076264	IL

General Provider Information

NPI Number	:	1992861918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SMITH MD

Provider Business Mailing Address
First Line	:	2200 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3905
Country	:	US
Telephone Number	:	773-768-2535
Fax Number	:	773-374-4079

Provider Business Practice Location Address
First Line	:	2200 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3905
Country	:	US
Telephone Number	:	773-768-2535
Fax Number	:	773-374-4079

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	12/08/2021

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Directions to “ GREGORY SMITH MD” Practice Location

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