Individual
DR. CHARLI WALTER LEROY SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
608 ROLLIE MOORE DR, HARRISBURG, IL 62946-2351
(618) 252-6150
Mailing address
7209 MOAKE SCHOOL RD, MARION, IL 62959-7782
(262) 488-2395
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036139019
IL
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
036139019
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP
IL
Enumeration date
07/11/2013
Last updated
05/13/2022
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