Individual
JACOB MATTHEW SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1044 N MOZART ST STE 100, CHICAGO, IL 60622-3644
(773) 292-8300
(773) 292-2601
Mailing address
1044 N MOZART ST STE 100, CHICAGO, IL 60622-3644
(773) 292-8300
(773) 292-2601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036149766
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/06/2016
Last updated
12/27/2019
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