Provider Demographics
NPI:1467707182
Name:SINGH, SMITA (MD)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 RIDGE AVE
Mailing Address - Street 2:MEDICAL EDUCATION
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3328
Mailing Address - Country:US
Mailing Address - Phone:847-316-6228
Mailing Address - Fax:
Practice Address - Street 1:355 RIDGE AVENUE
Practice Address - Street 2:MEDICAL EDUCATION
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3416
Practice Address - Country:US
Practice Address - Phone:847-207-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060921207R00000X
WI3639320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine