Provider Demographics
NPI:1467710079
Name:SMITH, LOIS
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16618 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-5829
Mailing Address - Country:US
Mailing Address - Phone:708-513-7192
Mailing Address - Fax:708-596-4600
Practice Address - Street 1:16618 WOOD ST
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-5829
Practice Address - Country:US
Practice Address - Phone:708-513-7192
Practice Address - Fax:708-596-4600
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies