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Individual
DR. BLAKE ALLEN SMITH
Active
Individual
DR. BLAKE ALLEN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004391
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016004391
IL LICENSE
IL
05
—
016004391
—
IL
01
—
07000838
IN LICENSE
IN
05
—
200136480E
—
IN
01
—
480017243
RAILROAD MEDICARE
IL
01
—
859800F
ADMINISTAR FEDERAL PIN
IN
01
—
P01675626
RAILROAD MEDICARE
IN
Enumeration date
07/06/2006
Last updated
10/21/2025
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