Individual
BONNIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2355 S WESTERN AVE, CHICAGO, IL 60608-3837
(732) 541-4007
(312) 829-6375
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
(312) 829-6375
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036150551
IL
Other
Enumeration date
05/18/2016
Last updated
08/23/2019
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