Organization
RUDYARD SMITH MD AND ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUDYARD U SMITH M.D., (PRESIDENT)
(773) 978-0757
Entity
Organization
Contact information
Practice address
1514 E 87TH ST, CHICAGO, IL 60619-6525
(773) 978-0757
(773) 978-0705
Mailing address
3510 W 79TH ST, CHICAGO, IL 60652-1430
(773) 978-0757
(773) 978-0705
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036053241
IL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053241001
—
IL
01
—
110233216
RAILROAD MEDICARE
IL
Enumeration date
06/13/2006
Last updated
05/31/2025
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