Provider Demographics
NPI:1679861371
Name:JAMIERE Y SMITH MD SC
Entity Type:Organization
Organization Name:JAMIERE Y SMITH MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIERE
Authorized Official - Middle Name:YOLANDE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-779-8285
Mailing Address - Street 1:5312 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4310
Mailing Address - Country:US
Mailing Address - Phone:773-779-8285
Mailing Address - Fax:773-324-2355
Practice Address - Street 1:9951 SOUTH HALSTED STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1035
Practice Address - Country:US
Practice Address - Phone:773-779-8285
Practice Address - Fax:773-779-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214485OtherMEDICARE
IL036087325Medicaid