Individual
KYLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8225 S OGLESBY, CHICAGO, IL 60617
(773) 793-9207
(312) 265-1212
Mailing address
8225 S OGLESBY AVE, CHICAGO, IL 60617-1927
(773) 793-9207
(312) 265-1212
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
172A00000X
Driver
Primary
—
—
Other
Enumeration date
02/03/2012
Last updated
02/03/2012
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