Provider Demographics
NPI:1689692949
Name:SMITH, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:STE 128
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:630-856-7460
Mailing Address - Fax:
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:STE 128
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-856-7460
Practice Address - Fax:630-655-9943
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360673972085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399690OtherMEDICARE GROUP NUMBER
IL399690OtherMEDICARE GROUP NUMBER