Individual
LETISHA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1921 MICHIGAN CITY RD APT 1E, CALUMET CITY, IL 60409-3724
(708) 955-4309
Mailing address
1921 MICHIGAN CITY RD APT 1E, CALUMET CITY, IL 60409-3724
(708) 955-4309
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
S53053374951
IL
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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