Provider Demographics
NPI:1407009103
Name:PAMELA E SMITH MD MPH CHES SC
Entity Type:Organization
Organization Name:PAMELA E SMITH MD MPH CHES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-542-0517
Mailing Address - Street 1:1950 S AVERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2450
Mailing Address - Country:US
Mailing Address - Phone:773-542-0517
Mailing Address - Fax:773-522-3637
Practice Address - Street 1:1950 S AVERS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2450
Practice Address - Country:US
Practice Address - Phone:773-542-0517
Practice Address - Fax:773-522-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062316174400000X, 207V00000X, 207VB0002X, 2083P0901X, 2085U0001X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42702OtherUPIN
IL036062316Medicaid
IL728780/PO7574Medicare PIN