Individual
MR. JUSTIN DARREN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
2520 ELISHA AVENUE, ZION, IL 60099
(847) 561-7460
Mailing address
11854 214TH AVENUE, BRISTOL, WI 53104
(847) 561-7460
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
238.000298
IL
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
09/14/2012
Last updated
03/27/2023
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