Organization
VA CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYRAN D SMITH MD (PHYSICIAN)
(224) 471-1812
Entity
Organization
Contact information
Practice address
901 MAPLE AVE, EVANSTON, IL 60202-1717
(224) 471-1812
Mailing address
901 MAPLE AVE, EVANSTON, IL 60202-1717
(224) 471-1812
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
984575447
—
IL
Enumeration date
10/31/2022
Last updated
10/31/2022
Update your record
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