DR. CARROLL EDWARD SMITH (NPI# 1386784346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386784346 |
| Entity Type | Individual |
| Full Name | DR. CARROLL EDWARD SMITH |
| Credential | M.D. |
| Practice Address |
4215 S King Dr Chicago IL 60653-2663 |
| Mailing Address |
4900 S Greenwood Ave Chicago IL 60615-2816 |
| Practice Telephone | 7736240366 |
| Practice Fax Number | 7736240367 |
| Mailing Telephone | 7732851392 |
| Mailing Fax Number | 7732852779 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
036-36570 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE LICENSE | 036-36570 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518264944 | Carroll Patton Smith | Counselor | 13745 25th Ave Ne, Seattle, WA 98125-3409 | 2011-02-21 |
| 1154664035 | Carroll Rudolph Smith IIi | Internal Medicine | 2201 Hempstead Tpke, East Meadow, NY 11554-1859 | 2013-03-29 |
| 1013206606 | Carroll Paul Smith | Social Worker | 720 Avignon Dr, Suite 3, Ridgeland, MS 39157-5166 | 2011-04-04 |
| Street Address |
4215 S KING DR |
| City | CHICAGO |
| State | IL |
| Zip Code | 60653-2663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881215804 | Pamela Ann Brazelton-sykes | Counselor | Pioneer Gardens Supportive Living, 3800 S King Dr, Chicago, IL 60653 | 2020-04-30 |
| 1962915439 | Pickup Transport Lllp | Non-emergency Medical Transport (VAN) | 4418 S. Oakenwald Ave, Chicago, IL 60653 | 2017-11-07 |
| 1245758309 | Qi Wellness LLC | Case Management | 525 E 46th Place, Chicago, IL 60653 | 2017-09-08 |
| 1598202897 | Fadesire O Ajuwon | Registered Nurse | 4218 S King Dr, 1n, Chicago, IL 60653 | 2017-01-24 |
| 1013464619 | Roundys Supermarkets Inc | Pharmacy | 3857 S Dr Martin Luther King Jr Dr, Chicago, IL 60653 | 2016-09-01 |
| 1417384793 | Griffin Orthodontics PC | Dentist | 1040 E 47th Street, Chicago, IL 60653 | 2013-10-02 |
| 1114350659 | Carita Dale Johnson | Pharmacist | 3753 S. Cottage Grove Ave, 104, Chicago, IL 60653 | 2013-08-20 |
| 1245677848 | Mercy Diagnostic and Treatment Center | Clinic/Center | 3755 S Cottage Grove, Chicago, IL 60653 | 2013-05-23 |
| 1952745937 | Mercy Community Pharmacy At Oakwood Shores | Pharmacy | 3753 S. Cottage Grove, Chicago, IL 60653 | 2013-04-22 |
| 1386952315 | Jami S Little | Developmental Therapist | 617 East 41st, Chicago, IL 60653 | 2010-09-24 |
| Find all providers in zip 60653 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043811425 | Devon Homecare Physicians Inc. | Family Medicine | 2822 W. Granville Ave. Apt 1, Chicago, IL 60659 | 2020-11-03 |
| 1447666318 | M & F Medical Services, Ltd | Family Medicine | 5642 N Christiana Ave, Chicago, IL 60659-4555 | 2014-07-10 |
| 1457767774 | Rambha Radhakrishnan | Family Medicine | 2645 W Peterson Ave, Chicago, IL 60659-4017 | 2014-07-08 |
| 1730444639 | Iqbal S Husain | Family Medicine | 6936 N Chicora Ave, Chicago, IL 60646-1508 | 2012-07-07 |
| 1033480413 | Healthworks Integrative Medical Clinic | Family Medicine | 1165 N Clark St Ste 608, Chicago, IL 60610-7848 | 2012-01-18 |
| 1518123843 | Nastane Le Bec | Family Medicine | 6225 S Kenwood Ave Apt 1s, Chicago, IL 60637-3766 | 2008-08-06 |
| 1639372410 | Albert R Rosanova Jr Ltd | Family Medicine | 5510 W Montrose Ave, Chicago, IL 60641-1330 | 2007-06-07 |
| 1386860997 | Mariya Dmytriv-kapeniak | Family Medicine | 2540 W Chicago Ave, Chicago, IL 60622-5019 | 2007-04-18 |
| 1255462578 | Roberto Diaz | Family Medicine | 1805 S Ashland Ave, Chicago, IL 60608-2805 | 2007-03-08 |
| 1265579262 | Maimanat Nizam | Family Medicine | 2001 W 69th St, Chicago, IL 60636-3262 | 2007-01-30 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.