Provider Demographics
NPI:1346223179
Name:SMITH, RICHARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:27401 WEST HIGHWAY 22
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-382-2320
Mailing Address - Fax:847-382-0837
Practice Address - Street 1:27401 WEST HIGHWAY 22
Practice Address - Street 2:SUITE 111
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-382-2320
Practice Address - Fax:847-382-0837
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053031207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36053031Medicaid
C44335Medicare UPIN
L68296Medicare UPIN
IL532110Medicare ID - Type Unspecified