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Organization
CHICAGOLAND PHYSICIAN CONSORTIUM, LLC
Active
Organization
CHICAGOLAND PHYSICIAN CONSORTIUM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUDYARD U SMITH M.D. (MEDICAL DIRECTOR)
(773) 459-9661
Entity
Organization
Contact information
Practice address
3510 W 79TH ST, CHICAGO, IL 60652-1430
(773) 459-9661
(312) 631-2892
Mailing address
3510 W 79TH ST, CHICAGO, IL 60652-1430
(773) 459-9661
(312) 631-2892
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Enumeration date
09/23/2016
Last updated
09/07/2017
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