Individual
KEVIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 YATES AVE, CALUMET CITY, IL 60409-3119
(709) 439-7951
Mailing address
530 YATES AVE, CALUMET CITY, IL 60409-3119
(708) 439-7951
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
01/20/2017
Last updated
01/20/2017
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