Provider Demographics
NPI:1689886202
Name:SMITH, ROXANNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4140 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:HOMETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:60456-1135
Mailing Address - Country:US
Mailing Address - Phone:708-422-5700
Mailing Address - Fax:708-422-9535
Practice Address - Street 1:9555 S 52ND AVE STE F
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3054
Practice Address - Country:US
Practice Address - Phone:708-422-5700
Practice Address - Fax:708-422-8225
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036117083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117083Medicaid