Individual
MS. IMELDA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1425 N RANDALL RD, ELGIN, IL 60123-2300
(847) 742-9800
Mailing address
2100 POWELL ST STE 900, EMERYVILLE, CA 94608-1844
(510) 350-2600
(510) 879-9084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004814
IL
Other
Enumeration date
09/05/2013
Last updated
02/13/2017
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