Individual
KEVIN M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1333 BURR RIDGE PKWY STE 200, BURR RIDGE, IL 60527-0833
(630) 756-5270
(574) 538-4859
Mailing address
1333 BURR RIDGE PKWY STE 200, BURR RIDGE, IL 60527-0833
(630) 756-5270
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-093367
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093367
—
IL
Enumeration date
08/29/2006
Last updated
06/05/2019
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